A randomised trial to compare cognitive outcome after gamma knife radiosurgery versus whole brain radiation therapy in patients with multiple brain metastases: research protocol CAR-study B

Schimmel, Wietske C. M.; Verhaak, Eline; Hanssens, Patrick; Gehring, Karin; Sitskoorn, Margriet M.

doi:10.1186/s12885-018-4106-2

Cited by 12 publications

(16 citation statements)

References 54 publications

(48 reference statements)

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“…The limited data currently available leave this question open for further study. It is likely that both treatments have at least a transient effect on cognition [ 44 ] with the impact and duration of side effects often varying between treatment approaches [ 45 – 47 ], their influence on capacity may also be transient in nature. There are, however, increasing concerns over the persistence of cognitive impairment experienced following whole brain radiation therapy; as such, treatment fields and dose should be considered when making capacity assessment.…”

Section: The Effect Of Tumour and Patient Profilesmentioning

confidence: 99%

The Effects of Brain Tumours upon Medical Decision-Making Capacity

et al. 2019

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Purpose of Review Informed consent is the integral part of good medical practice in patients with brain tumours. Capacity to consent may be affected by the brain disorder or its treatment. We intend to draw upon the current neuro-oncology literature to discuss the influence intracranial tumours have upon patients’ capacity to consent to treatment and research. Recent Findings We performed a systematic review of studies of capacity to consent for treatment or research in patients with intracranial tumours. The search retrieved 1597 papers of which 8 were considered eligible for review. Summary Although there are obvious inherent limitations to solely assessing cognition, most research consistently demonstrated increased risk of incapacity in brain tumour patients with cognitive impairment. Specific items in cognitive screening batteries, for example Semantic Verbal Fluency Test (SVFT), Hopkins Verbal Learning Test (HVLT-Recall), and Trail Making Test A/B (TMT), are simple, easily applied tests that may act as significant red flags to identify patients at increased risk of incapacity and who subsequently will require additional cognitive/psychiatric evaluation or more formal tests for capacity to consent for treatment or research.

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Section: The Effect Of Tumour and Patient Profilesmentioning

confidence: 99%

The Effects of Brain Tumours upon Medical Decision-Making Capacity

et al. 2019

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“…Furthermore, quality of life data confirming the clinical benefit of WBRT and its potential neurocognitive impact were not available. A currently recruiting study is expected to provide relevant data in this context (20). CAR-Study B is a prospective randomized trial comparing cognitive outcome after SRS or WBRT in patients with 11-20 newly diagnosed brain metastases on a contrast-enhanced MRI scan, KPS ≥70 and life expectancy of at least 3 months.…”

Section: Discussionmentioning

confidence: 99%

Patterns of Treatment and Outcome in Patients With 20 or More Brain Metastases

Nieder

Yobuta

Mannsåker

2018

In Vivo

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Background/Aim: The aim of this study was to analyze the patterns of treatment and outcomes in patients with a large number of brain metastases, arbitrarily defined as 20 or more lesions. These patients are typically excluded from studies of focal brain treatment, e.g., surgery or radiosurgery, and might have a limited prognosis. Patients and Methods: This was a retrospective single-institution analysis. Overall, 11 patients were identified from a prospectively maintained database. Results: Ten patients had received active treatment (9 whole-brain radiotherapy, 7 systemic therapy). Median survival was 5.0 months without long-term survival beyond 13 months. Patients with better performance status had numerically longer survival, however we did not identify baseline parameters with a significant impact on survival. Conclusion: While long-term survival was not observed in this small study, most patients survived long enough to experience symptomatic improvement from whole-brain radiotherapy. Therefore, we recommend multidisciplinary assessment of the patients' prognosis and systemic treatment options, and initiation of whole-brain radiotherapy if survival is not limited to 1-2 months. Advances in diagnostic imaging have facilitated detection of small intracranial lesions (1-3) and thus resulted in decreasing numbers of patients who present with 1-3 brain metastases from solid extracranial primary tumors, e.g., lung, breast, kidney cancer or malignant melanoma (4). Many patients with 1-3 brain metastases are considered adequate candidates for surgery and/or radiosurgery (SRS) (5-8). Technically, it is also 173 This article is freely accessible online.

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“…WBRT is typically used in cases of concurrent brain metastases or major meningeal cerebral involvement ( 45 ). For BM dose and fractionation scheme is at the discretion of the treating radiation oncologist, though most commonly used dose and fractionation schemes are 20 Gy in 5 fractions of 4 Gy (standard schedule in Europe) and 30 Gy in 10 fractions of 3 Gy ( 46 ). For LM focal radiation therapy is recommended on symptomatic, bulky or obstructive sites and the dose depends on performance status (20–40 Gy in 5–20 fractions), volume to treat and available techniques ( 47 ).…”

Section: Treatment Options Of Leptomeningeal Metastasesmentioning

confidence: 99%

Management of Leptomeningeal Metastases in Non-oncogene Addicted Non-small Cell Lung Cancer

et al. 2018

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Brain metastases in non-small cell lung cancer (NSCLC) patients are more often detected due to imaging modalities improvements but also emerge because of improved treatments of the primary tumor which lead to a longer survival. In this context, development of leptomeningeal metastases (LM) is a devastating complication and its prognosis remains poor despite advances in systemic and local approaches. Histology characterization of NSCLC and molecular expression influence LM management. For those with “oncogene addiction,” new generation epidermal growth factor receptor (EGFR) and anaplastic lymphoma kinase (ALK) tyrosine kinase inhibitors (TKIs) were developed to strongly penetrate the blood-brain barrier (BBB) with the aim to prevent central nervous system cancer dissemination, eventually impacting on LM appearance and its subsequent management. Systemic chemotherapy, often combined with intrathecal chemotherapy (when possible), was one of common indications for lung cancer patients affected by LM, without driver mutations and a good performance status but currently, with the advent of innovative systemic approaches treatment solutions in this subgroup of patients are rapidly evolving. Whole brain radiation therapy (WBRT) is the conventional treatment for patients with brain metastases. Furthermore, modern radiation techniques, as stereotactic radiotherapy (SRT), improve outcomes in those cases with a limited number of lesions. However, LM represent a minority of CNS metastases and few literature data are available to drive the radiotherapy approach. Considering all relevant progress made in this setting, after a literature review, the aim of this paper is to discuss about recent developments and therapeutic options in LM management of non-oncogene addicted NSCLC.

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A randomised trial to compare cognitive outcome after gamma knife radiosurgery versus whole brain radiation therapy in patients with multiple brain metastases: research protocol CAR-study B

Cited by 12 publications

References 54 publications

The Effects of Brain Tumours upon Medical Decision-Making Capacity

The Effects of Brain Tumours upon Medical Decision-Making Capacity

Patterns of Treatment and Outcome in Patients With 20 or More Brain Metastases

Management of Leptomeningeal Metastases in Non-oncogene Addicted Non-small Cell Lung Cancer

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