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.

Avoiding the Hippocampus During Whole-Brain Radiation Therapy in Treating Patients With Brain Metastases

Cognitive/Functional Effects

Metastatic Cancer

Unspecified Adult Solid Tumor, Protocol Specific

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.

intensity-modulated radiation therapy

A Phase II Trial of Hippocampal Avoidance During Whole Brain Radiotherapy for Brain Metastases

Change in Hopkins Verbal Learning Test-Revised delayed recall (HVLT_R DR) score from baseline to 4 months after the start of treatment calculated as (baseline score - 4 month score)/ baseline score. A positive change indicates a decline in function. The HVLT-R assesses verbal learning and memory. It incorporates 6 different forms, helping to mitigate practice effects of repeated administrations. Each form includes 12 nouns (targets) with 4 words drawn from 3 semantic categories, which differ across the 6 forms. Delayed recall involves recalling a list of 12 targets after a 20-minute delay. The score is the sum of the number of targets correctly recalled. Percent change calculated as 100*[(baseline score - 4 month score)/ baseline score]

The score is the total number of correct responses made in remembering the list on three consecutive trials in a single session. A higher score indicates a better performance. Each patient served as her or his own control, and the percent change in ISLT score from baseline to 4 months was calculated as 100*[(baseline score - 4 month score)/ baseline score].

The score is the arcsine of the square root of the proportion of correct responses. A higher score indicates a better performance. Each patient served as her or his own control, and the percent change in OCLT score from baseline to 4 months was calculated as 100*[(baseline score - 4 month score)/ baseline score].

The FACT-Br is a 19-item self-report instrument designed to measure multidimensional quality of life in patients with brain cancer. It is to be administered with the FACT-General. The FACT-G is a validated, 27-item measure where a higher score represents higher QOL. In addition to a total QOL score, subscale scores for physical, functional, social and emotional well-being are produced. There are 5 responses options, 0=Not a lot to 4=Very much. All subscale items are added together, multiplied by the number of items in the subscale, then divided by the number of items answered to obtain subscale totals. Scores range 0-108 for FACT-G total, 0-28 for physical, social, functional subscales, 0-24 for emotional subscale, 0-76 for brain subscale. Certain items must be reversed before it is added by subtracting the response from 4. Subscale requires >= 50% of items to be completed while the overall response rate must be > 80%. If items are missing, the subscale scores can be prorated.

The Barthel Index of Activities of Daily Living (ADL) is a 10-item assessment. Patient scores on the ADL range from 0 to 20 with lower scores indicating declining functional status.

Overall survival was measured from registration to the date of death or last known follow-up (censored). Kaplan-Meier estimator was used to median survival time and 95% confidence interval.

Progression (radiographic) is defined as an increase in perpendicular bidimensional tumor area (at lease 50% for lesions < 1cm, at least 25% for lesions >=1cm) for any of the 1-3 tracked brain metastases, or the appearance of any new brain metastasis on a follow-up MRI. Progression-free survival was calculated instead of time to progression. Progression-free survival time was measured from registration to the date of progression, death, or last known follow-up (censored). The Kaplan-Meier method used to determine median time (along with 95% confidence intervals).

For each patient the highest grade adverse event related to treatment was calculated. Those with their highest grade of 3 or higher were counted. Adverse events are graded using CTCAE v4.0. Grade refers to the severity of the AE. The CTCAE v4.0 assigns Grades 1 through 5 with unique clinical descriptions of severity for each AE based on this general guideline: Grade 1 Mild AE, Grade 2 Moderate AE, Grade 3 Severe AE, Grade 4 Life-threatening or disabling AE, Grade 5 Death related to AE

Per the protocol, the feasibility of the proposed translational studies were to be assessed following completion of accrual and sample collection. The decision was made not to pursue this outcome measure. No assays were performed and no data were collected for this Outcome Measure

Whole brain radiotherapy (WBRT) with hippocampal avoidance using intensity-modulated radiation therapy (IMRT)

UAB Comprehensive Cancer Center

Arizona Center for Cancer Care - Peoria

Mayo Clinic Scottsdale

Arizona Oncology - Tucson

Arizona Cancer Center at University of Arizona Health Sciences Center

Veterans Affairs Medical Center - Long Beach

Samuel Oschin Comprehensive Cancer Institute at Cedars-Sinai Medical Center

Radiological Associates of Sacramento Medical Group, Incorporated

University of California Davis Cancer Center

Avoiding the Hippocampus During Whole-Brain Radiation Therapy in Treating Patients With Brain Metastases

About this trial

Study ID

Status

Type

Phase

Placebo

Accepting

Not accepting

Trial Timing

What is this trial about?

What are the participation requirements?