Prospective memory impairment following whole brain radiotherapy in patients with metastatic brain cancer

Huang, Cheng; Chen, Haijun; Y, Lv; Chen, Zhendong; Li, Chiang‐Shan R.

doi:10.1002/cam4.1784

Cited by 18 publications

(13 citation statements)

References 39 publications

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“…For the latter, Trifiletti et al showed a latency period of 10,2 months after WBI [11]. In contrast, Cheng et al reported early cognitive impairment at one month after WBI, likely due to the frontal lobe damage [12]. Between these opposing positions, Kepka et al [13] supported that the omission of WBI after post-operative SRS delivered to the tumor bed affected the quality of life (QoL) and survival rates due to a poor sub-clinical disease control.…”

Section: Introduction/rationalementioning

confidence: 98%

Whole Brain Irradiation or Stereotactic RadioSurgery for five or more brain metastases (WHOBI-STER): A prospective comparative study of neurocognitive outcomes, level of autonomy in daily activities and quality of life

Ferini¹,

Viola²,

Valenti³

et al. 2022

Clinical and Translational Radiation Oncology

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To evaluate neurocognitive performance, daily activity and quality of life (QoL), other than usual oncologic outcomes, among patients with brain metastasis ≥5 (MBM) from solid tumors treated with Stereotactic Brain Irradiation (SBI) or Whole Brain Irradiation (WBI). Methods: This multicentric randomized controlled trial will involve the enrollment of 100 patients (50 for each arm) with MBM ≥ 5, age ≥ 18 years, Karnofsky Performance Status (KPS) ≥ 70, life expectancy > 3 months, known primary tumor, with controlled or controllable extracranial disease, baseline Montreal Cognitive Assessment (MoCA) score ≥ 20/30, Barthel Activities of Daily Living score ≥ 90/100, to be submitted to SBI by LINAC with monoisocentric technique and non-coplanar arcs (experimental arm) or to WBI (control arm). The primary endpoints are neurocognitive performance, QoL and autonomy in daily-life activities variations, the first one assessed by MoCa Score and Hopkins Verbal Learning Test-Revised, the second one through the EORTC QLQ-C15-PAL and QLQ-BN-20 questionnaires, the third one through the Barthel Index, respectively. The secondary endpoints are time to intracranial failure, overall survival, retreatment rate, acute and late toxicities, changing of KPS. It will be considered significant a statistical difference of at least 30% between the two arms (statistical power of 80% with a significance level of 95%). Discussion: Several studies debate what is the decisive factor accountable for the development of neurocognitive decay among patients undergoing brain irradiation for MBM: radiation effect on clinically healthy brain tissue or intracranial tumor burden? The answer to this question may come from the recent technological advancement

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Section: Introduction/rationalementioning

confidence: 98%

Whole Brain Irradiation or Stereotactic RadioSurgery for five or more brain metastases (WHOBI-STER): A prospective comparative study of neurocognitive outcomes, level of autonomy in daily activities and quality of life

Ferini¹,

Viola²,

Valenti³

et al. 2022

Clinical and Translational Radiation Oncology

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“…13 The most common and relevant adverse event related to WBRT is permanent neurocognitive impairment, which, in some cases, may outweigh its benefits. 14 Novel targeted therapies have improved CNS penetration and revealed potent intracerebral activity in patients with NSCLC with driver genes activating mutations and BM, even without previous RT. 15 Immunotherapy, alone or in combination with chemotherapy, is now the standard of care for first-line treatment of patients with NSCLC without an actionable driver mutation.…”

Section: Introductionmentioning

confidence: 99%

Immunotherapy as Single Treatment for Patients With NSCLC With Brain Metastases: A Systematic Review and Meta-Analysis—the META-L-BRAIN Study

Alencar

Camandaroba

Pirolli

et al. 2021

Journal of Thoracic Oncology

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“…Patients with a unique or a limited number of BM are considered eligible for treatment with complete surgical resection or stereotactic radiosurgery, and WBRT is preferably administered to patients with multiple BM ( 32 ). Complications following stereotactic radiosurgery such as radio necrosis and WBRT such as permanent neurocognitive impairment may outweigh the benefits ( 33 , 34 ). Therefore, RT sparing management has become increasingly attractive ( 35 ).…”

Section: Discussionmentioning

confidence: 99%

Lung cancer with brain metastases remaining in continuous complete remission due to pembrolizumab and temozolomide: a case report

Zhu¹,

Dong²,

Tang³

et al. 2022

Ann Transl Med

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Background Immunotherapy has been shown to improve the overall survival (OS) in patients with advanced or metastatic non-small cell lung cancer (NSCLC) without driver gene mutations. However, monotherapy with immunotherapy alone or combined with chemotherapy in NSCLC patients with untreated brain metastases (BM) is still under debate. Data regarding treatment of BM with immunotherapy and temozolomide (TMZ) in patients with NSCLC is rare. Case Presentation A 60-year-old male due to cough and expectoration presented in our hospital. Chest computed tomography (CT), brain magnetic resonance imaging (MRI) and immunohistochemistry of a mediastinal lymph node biopsy were administered, he was diagnosed with stage IIIB lung adenocarcinoma. Without driver gene mutations, he was treated with platinum-based chemotherapy because he refused to accept concurrent radiation therapy (RT). Heavy cough companied with hemoptysis and chest CT scan both revealed progressive disease (PD) after 6 cycles of chemotherapy. Immunotherapy was consequently considered, while two metastatic lesions in the brain were confirmed after combined treatment of pembrolizumab with docetaxel. TMZ was administered in combination with pembrolizumab (200 mg, day 1). A new metastasis in the right occipital lobe was detected on a scan 1 month later, though the other 2 lesions continued to shrink. The treatment was continued, MRI and CT scans suggested complete response (CR) was achieved for both the BM and lung lesions after 3 cycles. Consolidation therapy with TMZ and pembrolizumab (100 mg) per month was considered for another 7 months. Maintenance monotherapy with pembrolizumab (100 mg) was selected because of his stable CR status. At 59 months since diagnosis, the patient remains alive, with CR for both the primary lesions and BM. The patient experienced slight numbness on each side of his feet. There was no occurrence of adverse effects greater than grade 3. Conclusions The data indicates that immunotherapy combined with TMZ for untreated BM in NSCLC patients maybe an efficient and safe decision making therapeutic choice. Despite the encouraging efficacy of the combination, it is an isolated case and the speculation of synergism need to be proved in further pharmacokinetic/pharmacodynamic studies even in large randomized controlled trials.

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Prospective memory impairment following whole brain radiotherapy in patients with metastatic brain cancer

Cited by 18 publications

References 39 publications

Whole Brain Irradiation or Stereotactic RadioSurgery for five or more brain metastases (WHOBI-STER): A prospective comparative study of neurocognitive outcomes, level of autonomy in daily activities and quality of life

Whole Brain Irradiation or Stereotactic RadioSurgery for five or more brain metastases (WHOBI-STER): A prospective comparative study of neurocognitive outcomes, level of autonomy in daily activities and quality of life

Immunotherapy as Single Treatment for Patients With NSCLC With Brain Metastases: A Systematic Review and Meta-Analysis—the META-L-BRAIN Study

Lung cancer with brain metastases remaining in continuous complete remission due to pembrolizumab and temozolomide: a case report

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