Avoiding the Hippocampus During Whole-Brain Radiation Therapy in Treating Patients With Brain Metastases
Condition: Cognitive/Functional Effects; Metastatic Cancer; Unspecified Adult Solid Tumor, Protocol Specific
MeSH terms: Brain Neoplasms
Study type: Interventional
Phase: Phase 2

Summary: 
      RATIONALE: Radiation therapy uses high energy x-rays to kill tumor cells.

      PURPOSE: This phase II trial is studying how well avoiding the hippocampus during whole-brain
      radiation therapy works in treating patients with brain metastases.
    

Detailed description: 
      OBJECTIVES:

      Primary

        -  Evaluate delayed recall as assessed by the Hopkins Verbal Learning Test-Revised (HVLT-R)
           at 4 months after hippocampal avoidance during whole-brain radiotherapy (HA-WBRT) in
           patients with brain metastasis.

      Secondary

        -  Evaluate auditory and visual learning and memory, as assessed by two CogState tests
           (International Shopping List Test and One Card Learning Test), after HA-WBRT in these
           patients.

        -  Compare psychometric properties of the 2 CogState tests to the HVLT-R for the assessment
           of memory decline after HA-WBRT in these patients.

        -  Evaluate health-related quality of life [as assessed by the Functional Assessment of
           Cancer Therapy with Brain Subscale (FACT-BR) and the Barthel Index of Activities of
           Daily Living (ADLs)] after HA-WBRT in these patients.

        -  Evaluate time to radiographic progression after HA-WBRT in these patients.

        -  Evaluate overall survival of these patients after HA-WBR.

        -  Evaluate the adverse events of HA-WBR.

        -  Evaluate predictive biomarkers of cognitive function.

      OUTLINE: This is a multicenter study.

      Patients undergo 10 fractions of intensity-modulated whole-brain radiotherapy (WBRT),
      avoiding hippocampal (HA) regions, once daily, 5 days a week, for 2-2½ weeks.

      Patients neurocognitive functions (delayed recall, auditory and visual learning, and memory)
      are evaluated by the Hopkins Verbal Learning Test-Revised (HVTL-R), The One Card Learning
      Test (OCLT), and the International Shopping List Test (ISLT) at baseline and periodically
      during study.

      Patients may undergo serum, plasma, or whole blood collection at baseline and at 4 months
      after completion of HA-WBRT for correlative studies.

      Patients may complete the Functional Assessment of Cancer Therapy with Brain Subscale
      (FACT-BR), and the Barthel Index of Activities of Daily Living (ADLs) quality-of-life
      questionnaires at baseline and periodically during study and follow up.

      After completion of study therapy, patients are followed up periodically.
    

Intervention name(s): intensity-modulated radiation therapy
Intervention type(s): Radiation
Intervention description(s): 30 Gy in 10 fractions to the whole brain using intensity-modulated radiation therapy excluding the hippocampal avoidance area. Bilateral hippocampal contours manually generated on the fused planning MRI CT image set by the treating physician according to protocol-specified contouring instructions. Hippocampal avoidance regions generated by three-dimensionally expanding the hippocampal contours by 5 mm.
Other intervention name(s): IMRT
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: cognitive/functional effects; tumors metastatic to brain; unspecified adult solid tumor, protocol specific