Neurocognitive Effects Following Cranial Irradiation for Brain Metastases

Pinkham, Mark B; Sanghera, Paul; Wall, Gemma; Dawson, Benjamin H.; Whitfield, Gillian A

doi:10.1016/j.clon.2015.06.005

Cited by 29 publications

(18 citation statements)

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“…WBRT was used in over a fifth of all patients. WBRT is associated with significant neurocognitive impairment as well as alopecia (Pinkham et al, 2015). Using an IMRT solution to keep hippocampal doses below 9 Gy, neurocognitive impairment can be reduced from 30% to less than 10%; however, this is not in routine use in our centre (Gondi et al, 2014) (2013)).…”

Section: Discussionmentioning

confidence: 99%

“…Historically, patients were managed with whole‐brain radiotherapy (WBRT) with a role for neurosurgery in selected cases (Mehta et al, ). The results of the QUARTZ trial have led to WBRT falling out of favour in the UK for lung cancer patients (Mulvenna et al, ) and it is known neurocognitive toxicity has led to concerted efforts to manage brain metastases differently, either with hippocampal sparing WBRT or with stereotactic radiosurgery (SRS) (Gondi et al, ; Pinkham, Sanghera, Wall, Dawson, & Whitfield, ).…”

Section: Introductionmentioning

confidence: 99%

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Defining patterns of care in the management of patients with brain metastases in a large oncology centre: A single‐centre retrospective audit of 236 cases

et al. 2019

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Aims The role of selected treatments for brain metastases (BM) is well documented; however, the prevalence of these is not. We report on the patterns of care in the management of BM in a large oncology centre. Materials and methods We retrospectively audited 236 cases of newly diagnosed BM from January 2016 to December 2017 by looking at 2 years of radiology reports and gathered data on primary site, survival, treatment received, palliative care input and brain metastases‐related admissions. Results Eighty‐two per cent of cases were related to lung, breast and melanoma primaries. Half of patients received a form of treatment with the other half receiving best supportive care. Of these, whole‐brain radiotherapy (39%) and stereotactic radiosurgery (40%) were the most common treatment modalities. Most common reasons for admissions were headaches, seizures, weakness and confusion. Conclusion This is the first study in the UK that gives an in‐depth overview of the real‐world management of brain metastases. We have demonstrated the prevalence of treatment across the spectrum of brain metastases patients. Radiotherapy is the mainstay of treatment in nearly 80% of cases; however, care needs to be taken in ensuring that SRS is offered to those who are suitable.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Defining patterns of care in the management of patients with brain metastases in a large oncology centre: A single‐centre retrospective audit of 236 cases

et al. 2019

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“…WBRT was the historic standard of care prior to widespread use of SRS [19]. However, the principle concern with WBRT, particularly in patients with a more favourable prognosis, is the negative impact on neurocognitive function (NCF) and quality of life (QoL) [20]. NCF data is challenging to collect beyond a year and baseline impairment often occurs in the presence of brain metastases [21][22][23].…”

Section: Whole Brain Radiotherapy In Combination With Radiosurgerymentioning

confidence: 99%

The Expanding Role of Radiosurgery for Brain Metastases

O’Beirn

Benghiat

Meade

et al. 2018

Preprint

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Stereotactic radiosurgery (SRS) has become increasingly important in the management of brain metastases due to improving systemic disease control and rising incidence. Initial trials demonstrated SRS with whole brain radiotherapy (WBRT) improved local control rates versus WBRT alone. Concerns with WBRT associated neurocognitive toxicity have contributed to greater use of SRS alone, including for patients with multiple metastases and following surgical resection. Molecular information, targeted agents and immunotherapy have also altered the landscape for the management of brain metastases. This review summarises current and emerging data on the role of SRS in the management of brain metastases.

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“…Around 90% of BM patients evince some loss of cognitive function even before starting RT whilst in two thirds cases there are further losses in cognitive function following brain RT [64]. This deficit/deficiency is caused not only by the presence of brain cancer itself, but also through the progressive effects of extracranial chemotherapy (CHT) or adjuvant therapy (including the use of opioids, steroids) as well as the presence of comorbidities or the natural deterioration of cognitive functions in elderly patients [65,66].…”

Section: Cognitive Impairment/dysfunction Following Brain Rtmentioning

confidence: 99%

Hippocampal sparing in brain radiotherapy

Konopka-Filippow

Sierko²,

Wojtukiewicz³

2016

Nowotwory. Journal of Oncology

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Radiotherapy is one of the principal methods for treating brain cancer. Over recent years, a decline in patient quality of life has increasingly been observed in those undergoing brain irradiation, where hippocampal-dependent cognitive function has become impaired. The hippocampus is a paired structure of the limbic system situated in the medial temporal lobes of the telencephalon. Preliminary findings suggest that irradiation damaged neural stem cells in the hippocampus undergo apoptosis, resulting in deteriorating cognitive function. Despite the technical aspects for affording hippocampal avoidance during irradiation, much controversy still surrounds the techniques that shield the hippocampus without reducing the benefits of the intended radiotherapy for a given clinical condition. Furthermore, a tolerated radiation dose sufficient for preserving neural stem cell function has not been yet established. Delivering a method for an unequivocal assessment of cognitive function, post-irradiation, is also fraught with difficulty. Hitherto, only subjective psychological testing have been applied such as MMSE, HVLT or AVLT methods. Objective methods for optimally determining radiation-induced injury to the hippocampal region are still being investigated.

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Neurocognitive Effects Following Cranial Irradiation for Brain Metastases

Cited by 29 publications

References 88 publications

Defining patterns of care in the management of patients with brain metastases in a large oncology centre: A single‐centre retrospective audit of 236 cases

Defining patterns of care in the management of patients with brain metastases in a large oncology centre: A single‐centre retrospective audit of 236 cases

The Expanding Role of Radiosurgery for Brain Metastases

Hippocampal sparing in brain radiotherapy

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