Abstract

Background

Hippocampal avoidance whole-brain radiotherapy (HA-WBRT) shows potential for neurocognitive preservation. This study aimed to evaluate whether HA-WBRT or conformal WBRT (C-WBRT) is better for preserving neurocognitive function.

Methods

This single-blinded randomized phase II trial enrolled patients with brain metastases and randomly assigned them to receive HA-WBRT or C-WBRT. Primary endpoint is decline of the Hopkins Verbal Learning Test–Revised (HVLT-R) delayed recall at 4 months after treatment. Neurocognitive function tests were analyzed with a mixed effect model. Brain progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method.

Results

From March 2015 to December 2018, seventy patients were randomized to yield a total cohort of 65 evaluable patients (33 in the HA-WBRT arm and 32 in the C-WBRT arm) with a median follow-up of 12.4 months. No differences in baseline neurocognitive function existed between the 2 arms. The mean change of HVLT-R delayed recall at 4 months was −8.8% in the HA-WBRT arm and +3.8% in the C-WBRT arm (P = 0.31). At 6 months, patients receiving HA-WBRT showed favorable perpetuation of HVLT-R total recall (mean difference = 2.60, P = 0.079) and significantly better preservation of the HVLT-R recognition-discrimination index (mean difference = 1.78, P = 0.019) and memory score (mean difference = 4.38, P = 0.020) compared with patients undergoing C-WBRT. There were no differences in Trail Making Test Part A or Part B or the Controlled Oral Word Association test between the 2 arms at any time point. There were no differences in brain PFS or OS between arms as well.

Conclusion

Patients receiving HA-WBRT without memantine showed better preservation in memory at 6-month follow-up, but not in verbal fluency or executive function.

中文翻译：

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无美金刚的海马回避全脑放疗保护脑转移瘤的神经认知功能：一项 II 期盲法随机试验

摘要

背景

海马回避全脑放疗 (HA-WBRT) 显示出神经认知保留的潜力。本研究旨在评估 HA-WBRT 或适形 WBRT (C-WBRT) 是否更好地保护神经认知功能。

方法

这项单盲随机 II 期试验招募了脑转移患者，并将他们随机分配接受 HA-WBRT 或 C-WBRT。主要终点是治疗后 4 个月霍普金斯语言学习测试修订版 (HVLT-R) 延迟回忆的下降。神经认知功能测试采用混合效应模型进行分析。使用 Kaplan-Meier 方法估计脑无进展生存期 (PFS) 和总生存期 (OS)。

结果

从 2015 年 3 月到 2018 年 12 月，70 名患者被随机分配到总共 65 名可评估患者（HA-WBRT 组 33 名，C-WBRT 组 32 名）的队列中，中位随访时间为 12.4 个月。两组之间的基线神经认知功能不存在差异。4 个月时 HVLT-R 延迟回忆的平均变化在 HA-WBRT 组为 -8.8%，在 C-WBRT 组为 +3.8% ( P = 0.31)。在 6 个月时，接受 HA-WBRT 的患者表现出良好的 HVLT-R 总回忆（平均差异 = 2.60，P = 0.079）和显着更好地保留 HVLT-R 识别识别指数（平均差异 = 1.78，P = 0.019 ）和记忆力得分（平均差 = 4.38，P =0.020) 与接受 C-WBRT 的患者相比。在任何时间点，2 组之间的 Trail Making Test Part A 或 Part B 或受控口语联想测试没有差异。两组之间的脑 PFS 或 OS 也没有差异。

结论

接受不含美金刚的 HA-WBRT 的患者在 6 个月的随访中表现出更好的记忆保存，但在语言流畅性或执行功能方面则没有。