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Neurocognitive assessment following whole brain radiation therapy and radiosurgery for patients with cerebral metastases
  1. Susan G R McDuff1,
  2. Zachary J Taich1,
  3. Joshua D Lawson2,
  4. Parag Sanghvi2,
  5. Eric T Wong3,
  6. Fred G Barker II4,
  7. Fred H Hochberg4,
  8. Jay S Loeffler5,
  9. Peter C Warnke6,
  10. Kevin T Murphy2,
  11. Arno J Mundt2,
  12. Bob S Carter1,7,
  13. Carrie R McDonald8,9,
  14. Clark C Chen1,7
  1. 1Center for Theoretical and Applied Neuro-Oncology, University of California, La Jolla, California, USA
  2. 2Department of Radiation Medicine and Applied Sciences, University of California, La Jolla, California, USA
  3. 3Department of Neurology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  4. 4Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
  5. 5Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA
  6. 6Division of Neurosurgery, University of Chicago Medical Center, Chicago, Illinois, USA
  7. 7Division of Neurosurgery, University of California, La Jolla, California, USA
  8. 8Department of Psychiatry, University of California, La Jolla, California, USA
  9. 9Multimodal Imaging Laboratory, University of California, La Jolla, California, USA
  1. Correspondence to Dr Clark C Chen, Director of Stereotactic and Radiosurgery, Division of Neurosurgery, University of California, San Diego 3855 Health Science Drive #0987, La Jolla, CA 92093-0987, USA; clarkchen{at}ucsd.edu

Abstract

The treatment of metastatic brain lesions remains a central challenge in oncology. Because most chemotherapeutic agents do not effectively cross the blood–brain barrier, it is widely accepted that radiation remains the primary modality of treatment. The mode by which radiation should be delivered has, however, become a source of intense controversy in recent years. The controversy involves whether patients with a limited number of brain metastases should undergo whole brain radiation therapy (WBRT) or stereotactic radiosurgery (SRS) delivered only to the radiographically visible tumours. Survival is comparable for patients treated with either modality. Instead, the controversy involves the neurocognitive function (NCF) of radiating cerebrum that appeared radiographically normal relative to effects of the growth from micro-metastatic foci. A fundamental question in this debate involves quantifying the effect of WBRT in patients with cerebral metastasis. To disentangle the effects of WBRT on neurocognition from the effects inherent to the underlying disease, we analysed the results from randomised controlled studies of prophylactic cranial irradiation in oncology patients as well as studies where patients with limited cerebral metastasis were randomised to SRS versus SRS+WBRT. In aggregate, these results suggest deleterious effects of WBRT in select neurocognitive domains. However, there are insufficient data to resolve the controversy of upfront WBRT versus SRS in the management of patients with limited cerebral metastases.

  • Neurosurgery
  • Radiotherapy
  • Cognitive Neuropsychology
  • Memory
  • Neurooncology

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