Importance of the mini-mental status examination in the treatment of patients with brain metastases: a report from the radiation therapy oncology group protocol 91-04

Murray, Kevin; Scott, Charles; Zachariah, Babu; Michalski, Jeff M.; Demas, William F.; Vora, Nayana; Whitton, Anthony; Movsas, Benjamin

doi:10.1016/s0360-3016(00)00600-3

Cited by 83 publications

(60 citation statements)

References 7 publications

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“…More importantly, 51% of patients who had MMSE scores of 27 or less experienced significant improvement of MMSE at a median of 2.7 months after the treatment, regardless of which treatment they received initially. This finding supports the findings reported by Murray et al [9].…”

Section: Baseline Mmsesupporting

confidence: 83%

“…Neurocognitive function was assessed by the MMSE [8][9][10][11][12]. The MMSE is a short, standardized tool to grade cognitive function.…”

Section: Assessment Of Neurocognitive Functionmentioning

confidence: 99%

“…We also monitored neurocognitive function serially by the Mini-Mental Score Examination (MMSE) [8][9][10][11][12]. Herein, we present the results of detailed analysis of neurocognitive function for this trial.…”

Section: Introductionmentioning

confidence: 99%

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Neurocognitive Function of Patients with Brain Metastasis Who Received Either Whole Brain Radiotherapy Plus Stereotactic Radiosurgery or Radiosurgery Alone

Aoyama¹,

Tago²,

Kato³

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

497

304

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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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Section: Baseline Mmsesupporting

confidence: 83%

“…Neurocognitive function was assessed by the MMSE [8][9][10][11][12]. The MMSE is a short, standardized tool to grade cognitive function.…”

Section: Assessment Of Neurocognitive Functionmentioning

confidence: 99%

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Neurocognitive Function of Patients with Brain Metastasis Who Received Either Whole Brain Radiotherapy Plus Stereotactic Radiosurgery or Radiosurgery Alone

Aoyama¹,

Tago²,

Kato³

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

497

304

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“…(37). MMSE changes were followed in RTOG 9101, a randomized trial comparing standard whole brain radiotherapy to hyperfractionated radiation therapy for a similar group of patients (38). In that study, over 80% patients with a high initial MMSE score maintained a stable MMSE score at 3 months.…”

Section: Discussionmentioning

confidence: 99%

Randomized Phase II Trial of High-Dose Melatonin and Radiation Therapy for RPA Class 2 Patients With Brain Metastases (RTOG 0119)

Berk¹,

Berkey²,

Rich³

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

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Backround-RTOG 0119 was a Phase II randomized trial for RTOG RPA Class 2 patients with brain metastases to determine if high-dose melatonin improves survival over historical controls, and to determine if the time of day melatonin was given affects its toxicity or efficacy.Methods-RTOG RPA class 2 patients with brain metastases were randomized to 20 mg of melatonin given either in the morning (8-9 am) or evening (8-9 pm). All patients received radiation therapy (30 Gy in 10 fractions) in the afternoon. Melatonin was continued until neurological deterioration or death. The primary endpoint was overall survival time. Neurological deterioration as reflected by the Mini-Mental Status Exam was also measured.Results-Neither of the randomized groups had survival distributions that differed significantly from the historic control of patients treated with whole brain radiotherapy The median survivals of Corresponding Author: Lawrence Berk, MD, PhD, Radiation Oncology, Moffitt Cancer Center at Tampa General Hospital, 2 Columbia Dr., Tampa, FL 39606, E-mail: Berklb@moffitt.usf.edu. No conflicts of interest All patients gave IRB approved informed consent prior to enrolling on this trial.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access IntroductionMelatonin, an indoleamine molecule (N-acetyl, 5-methoxytryptamine) plays an important role in a number of processes including circadian rhythm regulation, sleep disorders, seasonal reproduction, retinal physiology, immune function, intermediary metabolism (1,2) and carcinogenesis. (3) It is also a highly efficient and potent free radical scavenger/antioxidant molecule and physiological blood levels of correlate with the total antioxidant capacity of the serum. (4) Oral ingestion of microgram amounts of melatonin results in near physiological nocturnal blood levels of melatonin. (5,6) The oral bioavailability of milligram doses of oral melatonin from nutritional supplements is about 15% (7) and results in supra-physiological melatonin levels.Numerous studies have demonstrated that physiological and pharmacological blood concentrations of melatonin inhibit tumorigenesis in a variety of in vivo and in vitro experimental models of neoplasia. (6,8,9) A preliminary study demonstrated that pretreatment of rats bearing hepatomas, for two weeks prior to a single dose of radiation administered just prior to lights off, with a non-tumor inhibiting dose of melatonin also given just before lights off, had a marked radiosensitizing effect. Pretreatment of tumor-bearing rats with AM doses of melatonin were ineffective. (10) The gre...

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“…The KPS is rated in increments of 10 on a scale of 0 to 100, with 100 meaning "normal, no complaints, no signs of disease" and 0 meaning "death". A score is assigned based on assessment by an observer such as a physician, nurse, or researcher 27 . Trials often use a performance score to describe their study population or as a component of the study's exclusion criteria-for example, patients below a certain KPS score are deemed ineligible 28,29 .…”

Section: Introductionmentioning

confidence: 99%

Quality of Life in Brain Metastases Radiation Trials: A Literature Review

et al. 2008

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BackgroundAn estimated 20%-40% of cancer patients will develop brain metastases. Whole-brain radiotherapy (WBRT) is the standard treatment for patients with brain metastases. Although WBRT can reduce neurologic symptoms, the median survival following WBRT is between 3 and 6 months. Given this limited survival, it is important to consider quality of life (QOL) when treating patients with brain metastases. However, few studies have focused on QOL and improvement in patient-rated symptoms as primary outcomes. ObjectiveFor an accurate measurement of the extent to which previous trials have utilized QOL tools to evaluate the efficacy of WBRT for treatment of brain metastases, we undertook a literature review to examine the common endpoints and QOL instruments used. MethodsWe conducted a systematic search using the MEDLINE (1950( to December 2007 and Cochrane Central Register of Controlled Trials (4th quarter 2007) databases. Eligible studies investigated WBRT in one of the study arms. The following outcomes were included: median survival, overall survival, neurologic function, 1-year local control, and overall response; use of QOL instruments, performance status scales, and neurologic function assessments; and use of other assessment tools. Patient-rated QOL instruments were defined as those that strove to assess all dimensions of QOL; observerrated performance instruments such as the Karnofsky performance status (KPS) were deemed to be performance scales. ResultsWe identified sixty-one trials that included WBRT nine evaluated the treatment of a single brain metastasis, and fifty-two evaluated the treatment of multiple brain metastases. Although fifty-five of the trials employed a QOL instrument, few trials focused on QOL as an outcome. We found 23 different instruments used to evaluate QOL. The most commonly employed instrument was the KPS (n = 33), followed by various neurologic function classification scales (n = 21). A preponderance of the studies used 1 (n = 26, 43%) or 2 (n = 21, 34%) QOL instruments.A total of fourteen published trials on brain metastases included an evaluation of the study population's QOL. Those trials included three that used the Functional Assessment of Cancer Therapy-General scale and Brain subscale instrument, three that used the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (C30) and the Brain Cancer Module 20 instrument, two that used study-designed QOL instruments, one that used the Edmonton Symptom Assessment Scale, two that used the Spitzer Quality of Life index, and three that used the KPS to evaluate QOL. Some trials reported deterioration in QOL after WBRT in patients with poorer prognosis; other trials detected an improvement in QOL after WBRT in patients with better prognosis. ConclusionsTo date, fourteen trials in brain metastases that have included an evaluation of the study population's QOL have been published. Although some studies showed that certain parameters of QOL deteriorate after WBRT, other studies showed that Q...

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Importance of the mini-mental status examination in the treatment of patients with brain metastases: a report from the radiation therapy oncology group protocol 91-04

Cited by 83 publications

References 7 publications

Neurocognitive Function of Patients with Brain Metastasis Who Received Either Whole Brain Radiotherapy Plus Stereotactic Radiosurgery or Radiosurgery Alone

Neurocognitive Function of Patients with Brain Metastasis Who Received Either Whole Brain Radiotherapy Plus Stereotactic Radiosurgery or Radiosurgery Alone

Randomized Phase II Trial of High-Dose Melatonin and Radiation Therapy for RPA Class 2 Patients With Brain Metastases (RTOG 0119)

Quality of Life in Brain Metastases Radiation Trials: A Literature Review

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