GRACE :: Radiation Oncology

whole brain radiation

Dr West

Can a drug reduce risk of cognitive side effects from whole brain radiation therapy?

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Last week, I wrote a post highlighting a relatively new blog and a review article about whole brain radiation therapy (WBRT) by my friend, Moffitt Cancer Center-based radiation oncologist Dr. Jacob Scott.   I found the review article to be among the very best I’ve ever encountered on this very important subject, but it only made passing reference to an important trial called RTOG (for Radiation Therapy Oncology Group) 0614, which randomized patients to WBRT with or without the agent memantine (Namenda), a medication for Alzheimer’s disease.  Memantine works by blocking glutamate receptors in the brain, which can excite brain cells, but at high levels of transmission, the effect can be harmful on memory formation and brain function.  Radiation oncologists developed the study to ask whether the this agent that can have a (modestly) beneficial effect on cognitive function on Alzheimer’s disease might also be beneficial in reducing cognitive deficits in patients who undergo WBRT.

I asked Dr. Scott for his thoughts on the recently reported preliminary results of the RTOG 0614 trial, which was among the most important results presented at the big radiation oncology conference in October of last year, called ASTRO (American Society for Radiation Oncology — I think the T is sometimes said to abbreviate “Therapeutic”, sometimes acknowledged as gratuitous to make an elegant abbreviation).  As described in a very nice follow-up post by Dr. Scott, the results suggested a borderline statistically significant result, with a p value just above our magic threshold of 0.05 that makes us more convinced that it should change our practice patterns.  

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Dr West

Brief Video: Systemic Therapy Alternative to Radiation for Multiple Brain Metastases?

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In most situations where a patient is diagnosed with multiple brain metastases in the setting of a new lung cancer, the recommended treatment will be radiation, often whole brain radiation (WBR).  But even if that’s the general rule, there are sometimes cases in which there’s good reason to consider making an exception.  Here’s my brief discussion of a case scenario in which I consider it a strong option to try systemic therapy before initiating brain radiation, and why I consider it to be an exception:

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