Whole brain radiation therapy can lead to memory, learning problems

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BOSTON—Cancer patients with brain metastases who undergo stereotactic radiosurgery (SRS) and whole brain radiation have more than double the risk of developing learning and memory problems, compared to those who only have stereotactic radiosurgery, according to a randomized study presented Tuesday at the 50th annual meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO).

“Results of this study show that initial stereotactic radiosurgery alone, coupled with close observation, could become the standard of care for patients newly diagnosed with brain metastases to best preserve their neurocognitive function,” said the study’s lead author Eric L. Chang, MD, a radiation oncologist at M.D. Anderson Cancer Center in Houston. “Results of this study could change the practice of how brain metastases are managed in the United States.”

The study involved 58 patients who were newly diagnosed with one, two or three brain metastases, and were randomized to receive SRS combined with whole brain radiation or SRS alone from January 2001 to September 2007, the researchers said.

The trial was halted after interim results showed that patients who received both SRS and whole brain radiation had a 49 percent decline in learning and memory functioning at four months, compared to patients who underwent SRS alone and who experienced a 23 percent decline in neurocognitive functioning.

Chang and colleagues measured the neurocognitive outcome by the ability of patients to immediately recall a list of 12 words after three attempts. For patients who received initial whole brain irradiation, nearly half of the patients lost the ability to recall five words from the same list over three attempts, compared to the same ability prior to treatment.