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Published on: October 18, 2011
Hippocampal Avoidance -Whole Brain Radiotherapy (HA-WBRT) with Simultaneous Integrated Boost (SIB) with Memantine in
A Joyce Christina1, Tanvir Pasha1, Nithin B Valuvil1
1Department of Radiation Oncology, Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India.
Background:
Brain metastasis (BM) significantly impacts survival and quality of life. Traditional whole-brain radiotherapy (WBRT) is associated with severe neurocognitive decline. Modern techniques like hippocampal-avoidance WBRT (HA-WBRT) with memantine may improve outcomes.
Objective:
To assess neurocognitive outcomes following HA-WBRT with a simultaneous integrated boost (SIB) and memantine in patients with oligo brain metastases.
Methods And Materials:
This prospective study, from September 2019 to March 2022, included 36 participants with oligo brain metastases. Inclusion criteria were age ≥18, histologically proven cancer, and KPS ≥70. Neurocognition and quality of life were assessed at baseline, 6 weeks, 3 months, and 6 months using Mini-Mental State Examination (MMSE), Trail Making Test Parts A and B (TMT A and B), Hopkins Verbal Learning Test (HVLT), and the EORTC BN20 questionnaire. All patients received oral memantine 10 mg BD from the start of radiotherapy up to 12 weeks post-therapy.
Results:
The study enrolled 36 patients, with a median age 50.5 years and a median follow-up of 8 months. Neurocognitive assessments showed significant improvements over time, except for TMT A. MMSE scores increased significantly from a baseline median 21.0 to 23.4 at 6 months (P < 0.0001). European Organisation for Research and Treatment of cancer (EORTC) quality of life (QOL) scores improved significantly from a baseline median 32.0 to 24.4 at 6 months (P < 0.0001). TMT B and HVLT scores also improved significantly. The complete response rate at 3 months was 26%, with a partial response rate of 56%. Median survival was 9.6 months.
Conclusions:
HA-WBRT with SIB and memantine is a valid option for BM patients, resulting in significantly better neurocognitive function and quality of life. Despite higher doses to the hippocampi, neurocognitive function improved significantly within 3 months post-radiotherapy. Further studies are needed to analyses survival and neurocognitive outcomes.
