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Complete brain radiotherapy can be administered more safely to patients with brain metastases by avoiding the hippocampus, according to a randomized phase III NRG Oncology trial presented at the annual meeting of the American Society of Radiation Oncology (ASTRO ).
To investigate the hypothesis that hippocampal stem cell radiation plays a role in cognitive decline, 518 patients were randomized to receive complete cerebral radiation plus memantine with or without avoidance of the disease. 39; hippocampus. The results of the clinical trial showed a 26% relative reduction in the risk of cognitive toxicity after whole brain radiotherapy with hippocampus avoidance compared to whole brain radiotherapy. The benefits of hippocampus avoidance for cognitive functions did not differ by age.
"This study demonstrates that we can offer radiation therapy to the entire brain with cognitive outcomes similar to those of radiosurgery," said lead author and co-principal investigator of the Phase III trial, Vinai Gondi, MD, director of research at Northwestern Medicine, Chicago Proton Center and co-investigator. Director, Brain Tumor Treatment Center, Northwestern Cancer Center, Warrenville. "The results of these trials are revolutionizing our understanding of the cognitive effects of brain irradiation in a way that has profound implications in terms of safer radiotherapy treatment of primary or metastatic brain tumors."
Brain metastases, cancer cells that have spread to the brain from primary tumors of other organs, are one of the most common cancerous conditions managed by radiation oncologists. Due to concerns about cognitive decline, radiation therapy of the entire brain is often the last resort, even though it is one of the most effective treatments for brain metastases.
"This hippocampus-sparing approach reduces both the risk of growth of new brain metastases and the risk of cognitive decline, and no previous study has ever demonstrated this dual effect," added Walter J. Curran, MD, Executive Director of the Winship Cancer Institute. Emory University and President of the NRG Oncology Group.
By establishing that the hippocampus region is sensitive to radiation, treatment plans for brain metastases or other brain tumors may use advanced techniques such as intensity-modulated radiation therapy (IMRT) or proton therapy to reduce the dose administered to the hippocampus and to offer a less toxic brain therapy. .
"Our phase III trial not only provides evidence of a change in practice in the management of brain metastases, but also relies on decades of preclinical and clinical research aimed at definitively establishing that The hippocampus is a specific radiosensitive and cognitive organ at risk during brain irradiation, Dr. Gondi said.
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