Concomitant treatment of brain metastases with whole brain radiotherapy and temozolomide protects neurocognitive function and improve quality of life
Purpose: To study the protective effects of a combination of temozolomide (TMZ) and whole brain radiotherapy (WBT) on neurocognition, and its effect on the quality of life (QoL) in patients with brain metastasis (BM) from solid tumors, relative to WBT alone.
Methods: A total of 256 BM patients were enrolled and divided into two groups treated with either WBT plus TMZ, or WBRT alone. All patients received 30 Gy WBT, with or without concomitant TMZ (75 mg/m2/day) during the irradiation period, and subsequently up to six cycles of TMZ (150 mg/m2/day).
Results: The mean intracranial objective response (IOR) for all patients was 44.80 % while the IOR for WBT arm and WBT+TMZ group arm were 32.48 and 56.56 %, respectively (p = 0.03). The median intracranial overall survival (OS) for all the patients was 7.70 months. The median OS for WBT alone group (6.53 months) was significantly shorter than that of the WBT + TMZ arm (9.57 months). Statistically significant difference in quality of life (QoL) was observed between both arms at six months. Moreover, WBT+TMZ group had higher incidence of toxicity, when compared to WBT-only group.
Conclusion: These results suggest that co-application of WBT and TMZ improves intracranial ORR and median OS in BM patients, relative to the use of WBT alone. Although the side effects may be increased as a result of addition of TMZ, toxicity is tolerable and manageable.
Keywords: Brain metastasis, Temozolomide, Whole brain radiotherapy, Neurocognition