umin.ac.jp/ctr Identifier: C000000412.

PURPOSEIt is not well known how the omission of whole-brain radiotherapy (WBRT) affects the neurocognitive function of patients with 1-4 brain metastases who are treated with stereotactic radiosurgery (SRS). MATERIALS AND METHODSIn a prospective randomized trial between WBRT+SRS and SRS-alone in patients with 1-4 brain metastases, neurocognitive function was assessed by the Mini-Mental Score Examination (MMSE). Among 132 enrolled patients, MMSE scores were available for 110 patients. RESULTSIn the baseline MMSE analyses, statistically significant differences were observed for total tumor volume, extent of tumor edema, age, and KPS. Among 92 patients who received follow-up MMSE, 39 patients had a baseline MMSE of 27 or lower (17 in the WBRT+SRS group, 22 in the SRS-alone group).Improvements of >=3 points in the MMSEs of 9 WBRT+SRS patients and 11 SRS-alone patients (P=0.85) were observed. Among 82 patients who had baseline MMSEs >=27 or whose baseline MMSEs were <=26 but improved to >=27 after the initial brain treatment, the 12-, 24-, and 36-month actuarial free Aoyama H et al. 4 rates of the 3-point drop in MMSE were 76.1%, 68.5%, and 14.7% in the WBRT+SRS group, and were 59.3%, 51.9%, and 51.9% in the SRS-alone group.The average duration until deterioration was 16.5 months in WBRT+SRS and 7.6 months in SRS-alone patients (P=0.05). CONCLUSIONSThe current study revealed that, for the majority of brain metastatic patients, control of the brain tumor is the most important factor for stabilizing neurocognitive function. However, the long-term adverse effect of WBRT on neurocognitive function may not be negligible.

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In patients with mild arteriographic disease without statistically significant dipyridamole-induced segmental myocardial perfusion defects caused by flow-limiting stenoses compared with normal control subjects, there was a graded, longitudinal, base-to-apex myocardial perfusion gradient significantly different from normal control subjects (P=0. 001) that was also observed for moderate to severe dipyridamole-induced segmental perfusion defects (P=0.0001), indicating diffuse disease underlying segmental perfusion defects; 43% of patients with or without segmental perfusion defects demonstrated graded, longitudinal, base-to-apex perfusion abnormalities beyond +/-2 SD of normal control subjects, indicating diffuse coronary arterial narrowing by noninvasive PET perfusion imaging.