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Targeted Brain Radiation Saves Memory

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For patients needing whole-brain radiotherapy (WBRT), avoidance of the hippocampal neural stem-cell compartment of the brain can help preserve memory and quality of life. These results were recently published in the Journal of Clinical Oncology.

Patients who have cancer that originated in the brain, has spread to the brain from other sites in the body, or has the potential of cancer spread to the brain, are often treated with radiation to the brain to kill the cancer cells. WBRT ensures that all areas of the brain receive radiation; however, side effects such as memory loss and overall quality of life measures can be affected by WBRT.

Researchers have been evaluating ways in which to reduce side effects caused by WBRT by avoiding radiation to areas of the brain that might affect specific aspects of cognition.

Recently, researchers affiliated with the Radiation Therapy Oncology Group (RTOG) conducted a clinical trial evaluating patients with cancer spread to the brain. The trial included 113 patients with cancer spread to their brain. They were treated with WBRT, except their hippocampal neural stem-cell compartment was spared radiation, as that part of the brain is associated with memory. Patients were tested with the Hopkins Verbal Learning Test-Revised Delayed Recall (HVLT-R DR) test at 4 months following radiation.

Historically, patients treated with WBRT experience a 30% decline on HVLT-R DR scores.
Patients in this trial whose hippocampal neural stem-cell compartment was spared during SBRT experienced only a 7% decline on the HVLT-R DR scores.
The researchers concluded that “Conformal avoidance of the hippocampus during WBRT is associated with preservation of memory and QOL as compared with historical series.”

Reference: Gondi V, Pugh S, Tome W, et al. Preservation of memory with conformal avoidance of the hippocampal neural stem-cell compartment during whole-brain radiotherapy for brain metastases (TOG 0933): a phase II multi-institutional trial. Journal of Clinical Oncology. 2014;32(3):3810-3816. http://jco.ascopubs.org/content/32/34/3810.abstract.