Neurocognitive assessment following whole brain radiation therapy and radiosurgery for patients with cerebral metastases

Susan G.R. McDuff, Zachary J. Taich, Joshua D. Lawson, Parag Sanghvi, Eric T. Wong, Fred G. Barker, Fred H. Hochberg, Jay S. Loeffler, Peter C. Warnke, Kevin T. Murphy, Arno J. Mundt, Bob S. Carter, Carrie R. McDonald, Clark C. Chen

Research output: Contribution to journalReview article

67 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1384-1391
Number of pages8
JournalJournal of Neurology, Neurosurgery and Psychiatry
Volume84
Issue number12
DOIs
StatePublished - Jan 1 2013

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Radiosurgery
Radiotherapy
Neoplasm Metastasis
Brain
Radiation
Cranial Irradiation
Cerebrum
Blood-Brain Barrier
Survival
Therapeutics
Growth

Cite this

Neurocognitive assessment following whole brain radiation therapy and radiosurgery for patients with cerebral metastases. / McDuff, Susan G.R.; Taich, Zachary J.; Lawson, Joshua D.; Sanghvi, Parag; Wong, Eric T.; Barker, Fred G.; Hochberg, Fred H.; Loeffler, Jay S.; Warnke, Peter C.; Murphy, Kevin T.; Mundt, Arno J.; Carter, Bob S.; McDonald, Carrie R.; Chen, Clark C.

In: Journal of Neurology, Neurosurgery and Psychiatry, Vol. 84, No. 12, 01.01.2013, p. 1384-1391.

Research output: Contribution to journalReview article

McDuff, SGR, Taich, ZJ, Lawson, JD, Sanghvi, P, Wong, ET, Barker, FG, Hochberg, FH, Loeffler, JS, Warnke, PC, Murphy, KT, Mundt, AJ, Carter, BS, McDonald, CR & Chen, CC 2013, 'Neurocognitive assessment following whole brain radiation therapy and radiosurgery for patients with cerebral metastases', Journal of Neurology, Neurosurgery and Psychiatry, vol. 84, no. 12, pp. 1384-1391. https://doi.org/10.1136/jnnp-2013-305166
McDuff, Susan G.R. ; Taich, Zachary J. ; Lawson, Joshua D. ; Sanghvi, Parag ; Wong, Eric T. ; Barker, Fred G. ; Hochberg, Fred H. ; Loeffler, Jay S. ; Warnke, Peter C. ; Murphy, Kevin T. ; Mundt, Arno J. ; Carter, Bob S. ; McDonald, Carrie R. ; Chen, Clark C. / Neurocognitive assessment following whole brain radiation therapy and radiosurgery for patients with cerebral metastases. In: Journal of Neurology, Neurosurgery and Psychiatry. 2013 ; Vol. 84, No. 12. pp. 1384-1391.
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