Paul D. Brown
Mayo Clinic radiation oncologist whose trials showed that focused radiosurgery preserves thinking and memory better than whole-brain radiotherapy for brain metastases, and that sparing the hippocampus reduces cognitive harm when whole-brain treatment is needed.
Overview
Paul Brown is a radiation oncologist at Mayo Clinic in Rochester who leads the North American cooperative-group trials on brain metastases. He was first author of the 2016 JAMA report of Alliance N0574, which showed less cognitive decline with radiosurgery alone than with radiosurgery plus whole-brain radiotherapy for one to three brain metastases; of the 2017 Lancet Oncology report of N107C, which established postoperative radiosurgery to the surgical cavity; and of the 2020 Journal of Clinical Oncology report of NRG CC001, which showed hippocampal avoidance with memantine reduces cognitive toxicity of whole-brain radiotherapy.
Where whole-brain radiotherapy is still chosen, for many metastases or leptomeningeal disease, hippocampal avoidance with memantine is the recommended technique.
Surgical cavity radiosurgery, rather than whole-brain radiotherapy, follows resection of a brain metastasis in fit patients, part of the broader move away from whole-brain treatment.
Patients with a limited number of brain metastases are treated with radiosurgery alone and surveillance, accepting more new brain lesions in return for preserved cognition.
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