A randomised phase II trial of hippocampal sparing versus conventional whole brain radiotherapy after surgical resection or radiosurgery in favourable prognosis patients with 1-10 brain metastases
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Authors
Whitfield, Gillian ABulbeck, H.
Clifton-Hadley, L.
Edwards, D.
Jefferies, S.
Jenkinson, M. D.
Griffin, M.
Handley, Julia
Megias, D.
Sanghera, P.
Shaffer, R.
Short, S.
Wilson, W.
Affiliation
The Christie NHS Foundation Trust, Manchester, UK.Issue Date
2024
Metadata
Show full item recordAbstract
AIMS: To assess in patients with 1-10 brain metastases, each of which has been treated by neurosurgery or stereotactic radiosurgery, whether hippocampal sparing whole brain radiotherapy (HS-WBRT) better spares neurocognitive function (NCF) than standard WBRT. Further, to assess whether a phase III randomised trial of HS-WBRT would be feasible in the UK. MATERIALS AND METHODS: A multicentre, randomised, open label phase II trial was undertaken, randomising patients to 30Gy in 10 fractions of WBRT or HS-WBRT. The primary endpoint was decline in Total recall using Hopkins Verbal Learning Test Revised (HVLT-R) at 4 months post treatment. To assess this, we aimed to recruit 84 patients over 3 years. Secondary endpoints included further measures of NCF, quality of life, duration of functional independence, local control of treated metastases, development of new metastases, disease control within the hippocampal regions, overall survival, steroid and antiepileptic medication requirements, and toxicity. RESULTS: The trial closed prematurely due to slower than anticipated recruitment. From April 2016 to January 2018, 23 patients were randomised. Follow up was a median of 25 months. Fifteen patients (6 WBRT, 9 HS-WBRT) were assessed for the primary endpoint; of these, 1 in each arm experienced significant decline in the 4-month HVLT-R Total recall score (p = 0.8). Patients in the HS-WBRT arm experienced less insomnia (p < 0.01) and drowsiness (p < 0.01). There were no differences in other secondary endpoints. CONCLUSION: A phase III randomised trial of HS-WBRT was shown not to be feasible at this time in the UK. As most randomised trials of HS-WBRT reported to date share common endpoints, including NCF, an individual patient data meta-analysis should be undertaken.Citation
Whitfield GA, Bulbeck H, Clifton-Hadley L, Edwards D, Jefferies S, Jenkinson MD, et al. A Randomised Phase II Trial of Hippocampal Sparing Versus Conventional Whole Brain Radiotherapy After Surgical Resection or Radiosurgery in Favourable Prognosis Patients With 1-10 Brain Metastases. Clinical oncology (Royal College of Radiologists (Great Britain)). 2024 Jul 4. PubMed PMID: 39030085. Epub 2024/07/20. eng.Journal
Clinical Oncology (Royal College of Radiologists)DOI
10.1093/ehjopen/oeae053PubMed ID
39030085Additional Links
https://dx.doi.org/10.1093/ehjopen/oeae053Language
enae974a485f413a2113503eed53cd6c53
10.1093/ehjopen/oeae053