Abstract
BACKGROUND: Brain metastases are considered one of the most serious complications of oncological illness. Although their optimal treatment remains still controversial, palliative whole brain radiotherapy (WBRT) is indicated in many patients because of numerous brain metastases, poor performance status or unmanageable extracranial illness. However, radiation of the hippocampus is supposed to development of late undesirable effects resulting in neurocognitive function (NCF) impairment with negative impact on quality of life in long-surviving patients. The aim of the project is to assess a correlation between neuronal depletion in the hippocampus measured by MR spectroscopy and relevant NCF alterations in patients after WBRT. METHODS: Patients with estimated longer survival based on standard prognostic indexes who were indicated for WBRT underwent MRI, MR spectroscopy focused on concentration of N-acetylaspartate (a neuronal marker), and quantitative psychological tests of the relevant mnestic functions. All the exams were then repeated 4 months after the WBRT and compared with the pre-radiotherapy results. Patients with brain metastases located in the hippocampal region and affecting the NCF by themselves were excluded form the study. RESULTS: Our preliminary data show alteration of the NCF after 4 months from radiotherapy accompanied by N-acetylaspartate concentration decline in the hippocampus reflecting a depletion of the neuronal pool. CONCLUSIONS: Our results support introduction of hippocampus-sparing radiotherapeutic methods in pursuit of minimalizing the side effects and improvement the quality of life. The project is supported by grants IGA MZCR NT/14120 and NT/14600 and the European Regional Development Fund Project FNUSA-IC RC (No. CZ.1.05/1.1.00/02.0123).