| Objective:The effects of different radiotherapy modes on the cognitive function of patients with 1-5 brain metastases(BM)were assessed by the Simple Mental State Scale(MMSE)and the Montreal Cognitive Rating Scale(MoCA).The differences in effective rate,local failure rate and survival rate were in the two groups were assessed within six months after radiotherapy.Methods:36 patients were collected from December 11,2015 to December 11,2016 in Oncology Department,Kunming General Hospital,with 1-5 brain metastases by MRI.The patients were divided into two groups,Group A was treated with whole brain radiotherapy and simultaneous integrated boost(WBRT+SIB).Prescription dose:whole brain total dose 41.4Gy/23 Fx/1.8 Gy,95%PGTV 55.2Gy/23 Fx/2.4 Gy,95%PTV 46Gy/23 Fx/2.0 Gy;Group B was treated the brain metastases by IMRT,without whole brain radiotherapy,Prescription dose:95%PGTV 55.2Gy/23Fx/2.4 Gy,95%PTV 46Gy/23 Fx/2.0 Gy.All patients were evaluated by MRI after radiotherapy.The changes of cognitive function in the two groups were evaluated by MMSE and MoCA scales in different time points after radiotherapy.Then the effective rate,local failure rate and survival rate within six months were evaluated respectively.Results:1.There were 36 patients in the whole group,and 5 cases were removed due to death.By PPS analysis,18 patients were enrolled in Group A(WBRT+SIB),and 13 patients was in group B(IMRT);The mean age was 54.4 years(29-75 years).The ratio of male and female was 2.6:1;2.Pathological data analysis:In FAS analysis,30 cases were lung cancer,and the ratio was 83.3%.In PPS analysis,the differences in age at onset and school education between the two groups were not significant(p>0.05);3.Cognitive function before radiotherapy:The cognitive function score evaluated by MMSE in WBRT+SIB group and IMRT group before radiotherapy were 26.8±3.19 and 28.0±1.83,respectively,while the cognitive function score by MoCA were 22.9±3.62 and 22.8±3.53,respectively.There were no significant differences in cognitive function between the two groups before radiotherapy(p>0.05);4.Changes in cognitive function in WBRT+SIB group:The cognitive function scored by MMSE in WBRT+SIB group at the end point,three months and six months after radiotherapy were 26.8±3.19、25.4±3.03and 24.8±2.88,respectively,while by MoCA,the scores were 22.9±3.62、21.3±3.79 and 20.5±3.85,respectively.By MMSE and MoCA,the cognitive functions of 3 months and 6 months after radiotherapy were lower than those before radiotherapy in WBRT+SIB group(p<0.05);5.Changes in cognitive function in IMRT group:The cognitive function scored by MMSE in IMRT group before radiotherapy,at the end point,three months,and six months after radiotherapy were 28.0±1.83、28.4±1.76、28.2±1.77、27.9±1.44and 27.7±1.65,respectively.There were no significant differences in cognitive function before and after radiotherapy in IMRT by MMSE(p>0.05).While by MoCA,the scores were 22.8±3.53,25.2±2.70,24.8±2.70 and 24.6±2.66,respectively.Compared with cognitive function before radiotherapy,the function were significantly improved at the end point,one months,and three months after radiotherapy by MoCA.There were significant differences between them(p<0.05);6.Differences of cognitive function between WBRT+SIB group and IMRT group:In WBRT+SIB group,the cognitive function at the end point,three months,and six months after rediotherapy were lower than those in IMRT group(p<0.05);.7.Effective rate in WBRT+SIB group and IMRT group:In WBRT+SIB group,the cases of CR and PR were 10 and 8,respectively.The rate of objective response was 100%.In IMRT group,the cases of CR and PR were 7 and 5,respectively.The rate of objective response was 92%.There were no significant differences between the two groups(p>0.05);8.Local failure rate of six months in WBRT+SIB group and IMRT group:The local failure rate of six months were 0%and 31%in WBRT+SIB group and IMRT group,respectively.There were significant differences between them(p<0.05);9.Survival rate of six months in WBRT+SIB group and IMRT group:The survival of six months were 100%in both groups.There were no significant differences between them(p>0.05);Conclusion:1.The cognitive functions of 3 months and 6 months after radiotherapy were lower than those before radiotherapy in WBRT+SIB group.2.The cognitive function of WBRT+SIB group was significantly lower than that of IMRT group at the end point,3 months,and 6 months after radiotherapy.3.IMRT group of patients with radiotherapy end,1 month after radiotherapy,3 months of cognitive function was significantly improved than before radiotherapy.4.The ORR and Survival rate of six months of intracranial lesions in WBRT+SIB group were no significant differences in IMRT group.However,the local failure rate of six months in IMRT group were higher than that in WBRT+SIB group. |
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