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Preservation of memory with conformal avoidance of the hippocampal neural stem-cell compartment during whole-brain radiotherapy for brain metastases (RTOG 0933): a phase II multi-institutional trial.


ABSTRACT: PURPOSE:Hippocampal neural stem-cell injury during whole-brain radiotherapy (WBRT) may play a role in memory decline. Intensity-modulated radiotherapy can be used to avoid conformally the hippocampal neural stem-cell compartment during WBRT (HA-WBRT). RTOG 0933 was a single-arm phase II study of HA-WBRT for brain metastases with prespecified comparison with a historical control of patients treated with WBRT without hippocampal avoidance. PATIENTS AND METHODS:Eligible adult patients with brain metastases received HA-WBRT to 30 Gy in 10 fractions. Standardized cognitive function and quality-of-life (QOL) assessments were performed at baseline and 2, 4, and 6 months. The primary end point was the Hopkins Verbal Learning Test-Revised Delayed Recall (HVLT-R DR) at 4 months. The historical control demonstrated a 30% mean relative decline in HVLT-R DR from baseline to 4 months. To detect a mean relative decline ? 15% in HVLT-R DR after HA-WBRT, 51 analyzable patients were required to ensure 80% statistical power with ? = 0.05. RESULTS:Of 113 patients accrued from March 2011 through November 2012, 42 patients were analyzable at 4 months. Mean relative decline in HVLT-R DR from baseline to 4 months was 7.0% (95% CI, -4.7% to 18.7%), significantly lower in comparison with the historical control (P < .001). No decline in QOL scores was observed. Two grade 3 toxicities and no grade 4 to 5 toxicities were reported. Median survival was 6.8 months. CONCLUSION:Conformal avoidance of the hippocampus during WBRT is associated with preservation of memory and QOL as compared with historical series.

SUBMITTER: Gondi V 

PROVIDER: S-EPMC4239303 | biostudies-literature | 2014 Dec

REPOSITORIES: biostudies-literature

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Preservation of memory with conformal avoidance of the hippocampal neural stem-cell compartment during whole-brain radiotherapy for brain metastases (RTOG 0933): a phase II multi-institutional trial.

Gondi Vinai V   Pugh Stephanie L SL   Tome Wolfgang A WA   Caine Chip C   Corn Ben B   Kanner Andrew A   Rowley Howard H   Kundapur Vijayananda V   DeNittis Albert A   Greenspoon Jeffrey N JN   Konski Andre A AA   Bauman Glenn S GS   Shah Sunjay S   Shi Wenyin W   Wendland Merideth M   Kachnic Lisa L   Mehta Minesh P MP  

Journal of clinical oncology : official journal of the American Society of Clinical Oncology 20141027 34


<h4>Purpose</h4>Hippocampal neural stem-cell injury during whole-brain radiotherapy (WBRT) may play a role in memory decline. Intensity-modulated radiotherapy can be used to avoid conformally the hippocampal neural stem-cell compartment during WBRT (HA-WBRT). RTOG 0933 was a single-arm phase II study of HA-WBRT for brain metastases with prespecified comparison with a historical control of patients treated with WBRT without hippocampal avoidance.<h4>Patients and methods</h4>Eligible adult patient  ...[more]

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