Plenary Oral Presentations - Macquarie University Hospital

16 th International Meeting of the Leksell Gamma Knife ® SocietyMarch 2012, Sydney, AustraliaMA-180Evaluation of mini-mental status examination score obtainedafter using gamma knife radiosurgery as the initial radiationtreatment for brain metastasesKiyoshi NakazakiDepartment of Neurosurgery, Brain Attack Center Ota Memorial HospitalObjective: This study aimed to evaluate (1) the mini-mental status examination scores (MMSEs) ofpatients with brain metastases, after they underwent gamma knife radiosurgery (GKS) without wholebrainradiation treatment (WBRT) and (2) the factors influencing MMSEs.Methods: Between January 2009 and June 2011, all patients with new brain metastases, i.e., 119patients, were treated using 1 session of GKS without WBRT as initial radiation therapy. MMSEswere determined for all patients before GKS and for the surviving patients at every 3 months afterGKS.Results: We could evaluate 76 patients (63.9%) after GKS. The median age, number of brain metastases,and total volume of brain metastases were 65.5 years (range, 40–92 years), 2 (range, 1–18), and4.17 ml (range, 0.04–27.0 ml), respectively. The median values for marginal dose, total skull integraldose, and MMSE follow-up time were 22.0 Gy (range, 14–24 Gy), 2.9 joules (range, 0.1–9.6 joules),and 5.8 months (range, 0.9–21.6 months), respectively.Thirty-nine patients (51.3%) developed newdistant lesions after the first GKS. The median survival time with or without follow-up MMSEs was8.8 and 2.8 months, respectively.The median pre-GKS MMSE in cases where follow-up MMSEs were obtained was 28 (range, 3–30).Thirty-eight patients (50.0%) had a pre-GKS MMSE of 3 points and those of 15 patients (19.7%) deteriorated by >3 points. For 4of these 15 patients, the cause of deterioration was not directly related with brain metastases; for 4of the remaining 11 patients, the deterioration in MMSEs recovered to within 3 points. The 6- and12-month actual free rates of the 3-point drop in the MMSEs were 83.9% (47 of 56 cases) and 79.2%(19 of 24 cases), respectively. Larger tumor volume was associated with an improvement of >3 pointsin the follow-up MMSE. No risk factors were significantly associated with a deterioration of >3 pointsin the follow-up MMSEs.Conclusion: GKS stabilizes neurocognitive function with less adverse effects. The mental deteriorationof patients with large symptomatic metastatic tumors tends to decrease after GKS.44