This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Li, J. Articles by Mehta, M. P. Search for Related Content PubMed PubMed Citation Articles by Li, J. Articles by Mehta, M. P. Related Articles Related Correspondence Social Bookmarking                            What's this?

Regression After Whole-Brain Radiation Therapy for Brain Metastases Correlates With Survival and Improved Neurocognitive Function

Jing Li, Soren M. Bentzen, Markus Renschler, Minesh P. Mehta

From the Department of Human Oncology, University of Wisconsin Comprehensive Cancer Center, Madison, WI; and Oncology Clinical Development, Pharmacyclics, Sunnyvale, CA

Address reprint requests to Minesh P. Mehta, MD, Department of Human Oncology, University of Wisconsin Comprehensive Cancer Center, 600 Highland Ave, Madison, WI 53792; e-mail: mehta{at}humonc.wisc.edu

Purpose Brain metastasis (BM) is a major cause of suffering and health costs in cancer patients. Whole-brain radiation therapy (WBRT) offers tumor shrinking and palliation in many cases, but it has been speculated that these benefits may be outweighed by adverse effects on neurocognitive function (NCF).

Patients and Methods Two hundred eight BM patients from the WBRT arm of phase III trial PCI-P120-9801 evaluating motexafin gadolinium were analyzed. NCF, assessed by tests of memory, executive function, and fine motor coordination, was correlated to magnetic resonance imaging–measured BM volume. NCF and survival were compared in 135 patients assessable at 2 months with tumor shrinkage below (poor responders) and above (good responders) the population median (45%). Mean NCF scores and BM volume at 4 and 15 months were compared.

Results Good responders experienced a significantly improved survival (unidirectional P = .03). For all tests, the median time to NCF deterioration was longer in good compared with poor responders, with statistical significance seen for Trailmaking B (executive function), and two Pegboard tests (fine motor). In long-term survivors, tumor shrinkage significantly correlated with preservation of executive function and fine motor coordination (r = 0.68 to 0.88). During the early follow-up period, the population mean NCF scores were dominated by patients with progressive disease. A small subset of 15-month survivors had stable or improving scores, and greater mean BM reduction.

Conclusion WBRT-induced tumor shrinkage correlates with better survival and NCF preservation. NCF is stable or improved in long-term survivors. Tumor progression adversely affects NCF more than WBRT does, thus making enhancement of radiation response a worthwhile aim in this patient population.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

Related Correspondence

• Avoiding Bias in the Prospective Evaluation of Patients With Brain Metastases
  Dirk Vordermark
  JCO 2007 25: 4023 [Full Text]

This article has been cited by other articles:

				F. Meyer, M. Ehrlich, and J. Peteet Psycho-Oncology: A Review for the General Psychiatrist Focus, July 1, 2009; 7(3): 317 - 331. [Abstract] [Full Text] [PDF]

				D. Vordermark Avoiding Bias in the Prospective Evaluation of Patients With Brain Metastases J. Clin. Oncol., September 1, 2007; 25(25): 4023 - 4023. [Full Text] [PDF]

				J. Li, S. M. Bentzen, M. P. Mehta, and M. Renschler In Reply J. Clin. Oncol., September 1, 2007; 25(25): 4024 - 4025. [Full Text] [PDF]