Feature | September 30, 2013

Avoiding Specific Region of Brain During Whole-Brain Radiotherapy Prevents Memory Loss

Radiation therapy clinical trial study whole brain radiotherapy

October 1, 2013 — Limiting the amount of radiation absorbed in the hippocampal portion of the brain during whole-brain radiotherapy (WBRT) for brain metastases preserves memory function in patients for up to six months after treatment according to research presented at the American Society for Radiation Oncology’s (ASTRO’s) 55th Annual Meeting.

The single-arm, phase II study was a multi-institutional, international clinical trial in the United States and Canada, conducted through the Radiation Therapy Oncology Group (RTOG). Researchers compared the study group to a historical control group of patients who received WBRT without hippocampal avoidance in the PCI-P-120-9801 phase III trial (Li 2007).

This study enrolled 113 adult patients from 2011 through 2013. The patients had measurable brain metastases outside a 5-mm margin around the hippocampus. Of those patients, 100 were analyzable and 76 percent were categorized as recursive partitioning analysis (RPA) class II. All patients received hippocampal avoidance whole-brain radiotherapy (HA-WBRT) to 30 Gy in 10 fractions. In all analyzable patients, the dose received by the entirety of the hippocampus did not exceed 10 Gy and the maximum dose did not exceed 17 Gy. Patients were assessed using the Hopkins Verbal Learning Test - Delayed Recall (HVLT-DR), the HVLT - Recall (HVLT-R) and the HVLT - Immediate Recognition (HVLT-IR) at baseline and post-treatment after two, four and six months. The primary endpoint of the trial was the HVLT-DR at four months.

Results showed the 42 patients who were analyzable at four months post-RT had a 7 percent decline in HVLT-DR from baseline to four months (95 percent confidence interval (CI): -4.7 percent to 18.7 percent). This is statistically significant when compared to the historical control group (p=0.0003), which demonstrated a 30 percent decline in HVLT-DR at four months. Six months after treatment, the 29 analyzable patients had a 2 percent decline in HVLT-DR from baseline (95 percent CI: -9.2 percent to 13.1 percent).

“Radiotherapy to the brain is known to impact the memory function of cancer survivors,” said Vinai Gondi, M.D., lead author of the study, co-director of the Cadence Brain Tumor Center, associate director of research at the Cadence Proton Center in Warrenville, Ill., and clinical assistant professor at the University of Wisconsin School of Medicine and Public Health in Madison, Wis. “A compartment of neural stem cells located in the hippocampus, sensitive to radiotherapy and important for memory function, is thought to be central to these effects. Our research group developed advanced radiotherapy techniques that spare this hippocampal neural stem cell compartment from significant radiation doses. The study results were statistically better than historical data of whole-brain radiotherapy without hippocampal sparing and present a number of opportunities to introduce hippocampal sparing in other contexts of radiotherapy to the brain. The RTOG is currently developing phase III trials to explore these other contexts and to validate these results.”

The abstract, “Memory Preservation with Conformal Avoidance of the Hippocampus during Whole-Brain Radiotherapy (WBRT) for Patients with Brain Metastases: Primary Endpoint Results of RTOG 0933,” was presented in detail during the plenary session at ASTRO’s Annual Meeting Sept. 23.

For more information: www.astro.org

Related Content

Sponsored Content | Videos | Radiation Therapy | January 18, 2019
Join Chris Toth, president of Varian’s Oncology Systems business, for a look at product introductions for 2018 plus
Novel Technique May Significantly Reduce Breast Biopsies
News | Breast Biopsy Systems | January 17, 2019
A novel technique that uses mammography to determine the biological tissue composition of a tumor could help reduce...
Digital Mammography Increases Breast Cancer Detection
News | Mammography | January 16, 2019
The shift from film to digital mammography increased the detection of breast cancer by 14 percent overall in the United...
MIM Software Inc. Receives FDA 510(k) Clearance for Molecular Radiotherapy Dosimetry
Technology | Nuclear Imaging | January 16, 2019
MIM Software Inc. received 510(k) clearance from the U.S. Food and Drug Administration (FDA) for molecular radiotherapy...
Artificial Intelligence Used in Clinical Practice to Measure Breast Density
News | Artificial Intelligence | January 15, 2019
An artificial intelligence (AI) algorithm measures breast density at the level of an experienced mammographer,...
Machine Learning Uncovers New Insights Into Human Brain Through fMRI
News | Neuro Imaging | January 11, 2019
An interdisciplinary research team led by scientists from the National University of Singapore (NUS) has successfully...
Mobile App Data Collection Shows Promise for Population Health Surveys
News | Population Health | January 10, 2019
Mobile app data collection can bring access to more potential clinical study participants, reduce clinical study...
Hypertension With Progressive Cerebral Small Vessel Disease Increases Cognitive Impairment Risk
News | Magnetic Resonance Imaging (MRI) | January 08, 2019
Patients with high blood pressure and progression of periventricular white matter hyperintensities showed signs of...
Artificial Intelligence Pinpoints Nine Different Abnormalities in Head Scans

A brain scan (left) showing an intraparenchymal hemorrhage in left frontal region and a scan (right) of a subarachnoid hemorrhage in the left parietal region. Both conditions were accurately detected by the Qure.ai tool. Image courtesy of Nature Medicine.

News | Artificial Intelligence | January 07, 2019
The rise in the use of computed tomography (CT) scans in U.S. emergency rooms has been a well-documented trend1 in...
Electronic Brachytherapy Effective in Long-Term Study of 1,000 Early-Stage Breast Cancers
News | Brachytherapy Systems, Women's Healthcare | January 07, 2019
Breast cancer recurrence rates of patients treated with intraoperative radiation therapy (IORT) using the Xoft Axxent...