PURPOSE To assess the neurocognitive function and neurological toxicity of frameless linear accelerator (LINAC)-based stereotactic radiosurgery (SRS) in patients with 10 or more brain metastases (BM). PATIENTS AND METHODS Forty consecutive adult patients who received SRS for ten or more 10 BM < 3 cm in maximum size were evaluated. All plans were generated using a single-isocenter multiple-target (SIMT) SRS technique with doses of 22 Gy for lesions < 2 cm and 16-18 Gy for those ≥ 2 cm in size. Survival analyses were estimated by Kaplan-Meier method from the date of SRS. Neurocognitive function using the Hopkins verbal learning test-revised (HVLT-R) and activity of daily living scale (ADLS) were collected prospectively at baseline and at 3,6 and 12-month follow-up. Toxicity was assessed by the National Cancer Institute Common Toxicity Criteria for Adverse Events (Version 5.0). RESULTS With a median follow-up of 10.8 months, 1-year survival and local control rates were 65% and 86%, respectively. Grade 2 or 3 toxicity occurred in eleven patients, being associated with radiological changes suggestive of radiation necrosis in seven patients. Three months after SRS, the mean relative decline was 14.2% for HVLT-R delayed recall, 12.3% for HVLT-R recognition, and 9.8% for HVLT-R total recall. A significant deterioration of HVLT-R scores ranged from 5.5 to 18.7% of patients at different time points. ADLS scores declined over time, but changes were not significant. CONCLUSIONS SRS is an effective and safe approach for patients with 10 or more BM able to maintain the pretreatment neurocognitive function in the majority of patients.

中文翻译：

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使用基于无框直线加速器（LINAC）的立体定向放射外科手术治疗的10例或10例以上脑转移患者的神经学结局和记忆表现。

目的评估基于无框架直线加速器（LINAC）的立体定向放射外科手术（SRS）对有10个或更多脑转移（BM）的患者的神经认知功能和神经毒性。患者与方法对四十名连续接受SRS治疗的连续成年患者进行了评估，这些患者接受最大尺寸的10 BM或10 BM <3 cm。所有计划都是使用单等中心多目标（SIMT）SRS技术生成的，对于小于2 cm的病变，剂量为22 Gy，对于≥2 cm的病变，剂量为16-18 Gy。从SRS开始，通过Kaplan-Meier方法评估生存分析。使用基线霍普金斯语言学习测验修订版（HVLT-R）和日常生活活动量表（ADLS）进行神经认知功能的收集，分别在基线，3,6和12个月的随访中进行。毒性由美国国家癌症研究所不良事件通用毒性标准（版本5.0）评估。结果平均随访10.8个月，一年生存率和局部控制率分别为65％和86％。11例患者发生2或3级毒性，这与7例患者的放射学改变提示放射线坏死有关。SRS后三个月，HVLT-R延迟召回的平均相对下降为14.2％，HVLT-R识别的平均下降为12.3％，HVLT-R总召回的平均下降为9.8％。在不同时间点，HVLT-R评分的显着恶化范围为患者的5.5％至18.7％。ADLS分数随时间下降，但变化不明显。