NRG CC001: hippocampal-avoidance whole-brain radiotherapy plus memantine for brain metastases
When whole-brain radiotherapy is needed, shaping the beams to spare the hippocampus and adding memantine reduced the memory and thinking decline that the treatment causes, with no loss of tumour control.
Overview
Phase 3 trial of 518 patients with brain metastases randomised to whole-brain radiotherapy with memantine, with or without hippocampal avoidance using intensity-modulated techniques.
Cognitive failure was less frequent with hippocampal avoidance (hazard ratio 0.74), driven by less decline in executive function and memory, with no difference in overall survival, intracranial progression or toxicity.
- Risk of cognitive failure reduced by 26 percent with hippocampal avoidance.
- No difference in survival or intracranial progression.
Where whole-brain radiotherapy is still chosen, for many metastases or leptomeningeal disease, hippocampal avoidance with memantine is the recommended technique.
- Excluded patients with metastases within 5 mm of the hippocampus.
- Requires intensity-modulated planning capability.