Central Nervous System
PV QA 2 - Poster Viewing Q&A 2
Purpose/Objective(s): Prognostic scores for brain metastasis patients is usefull for clinical decision making. This study aims to evaluate a computerised cognitive test -named Interhemispheric transfer time test (IHTTT)- for predicting cerebral progression-free survival and overall survival in patients undergoing stereotactic radiation therapy for brain metastases. The IHTTT is a quick computerised neurocognitive test assessing information processing speed impairment. A patient is sitting in front of a computer with a joystick in his hands. An arrow appears to the right or left of the screen and indicates the right or left. The patient should click right when the arrow indicates right and left when the arrow indicates left. It measures in milliseconds the time between the moment the arrow appears and the moment the patient clicks (IHTT).
Materials/Methods: Medical inclusion criteria: patients≥18 years, with 1 to 4 brain metastases treated by stereotactic radiotherapy (SRT) with dose schedule: 33 Gy in 3 fractions, with a solid tumour, ≥70 Karnofsky Performance Status, with Mini-Mental State Evaluation (MMSE) ≥ 24, without medical history of stroke brain injury. Twenty-nine patients were recruited prospectively at a single institution from June 2014 to April 2015. All recruited patients were administered an IHTTT, a MMSE, the Frontal Assessment Battery at Bedside (FAB), a Graded Pronostic Assessment (GPA) and a quality of life questionnaire (QLQ C30) before SRT. Univariate and multivariate Cox proportional hazard models of progression-free survival (PFS) and overall survival (OS) were conducted for these scores.
Results: Median follow-up was 35 months (SD ± 3). Median survival was 15 months and mean survival was 11.50 months (SD ± 1.45) We found a mean cerebral progression-free survival of 10 months for 78% of patients. Progression-free median survival was not achieved. Univariate analysis showed that a low IHTT was significantly associated with better overall survival (p=0.05) and better progression free-survival (p=0.03). Moreover, GPA was less associated with overall survival and progression free survival than IHTT (p=0.11 and p= 0.06). Multivariate analysis revealed that predictive factors for better progression-free survival were low IHTT (p=0.023) and low GPA score (p=0.038). MMSE, FAB scores and QLQ C30 scores were not associated with overall survival and progression-free survival.
Conclusion: Passing an IHTTT before deciding on cerebral therapeutic strategy could be interesting as a way of better selecting patients. The test seems predictive of progression-free survival and could therefore be a new tool to be incorporated into the therapeutic decision.
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