Presented in part as an abstract at the 2011 Annual Meeting of the American Society of Clinical Oncology; June 3-7; Chicago, Illinois.
Preservation of neurocognitive function and local control of 1 to 3 brain metastases treated with surgery and carmustine wafers
Article first published online: 23 AUG 2013
© 2013 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
Volume 119, Issue 21, pages 3830–3838, 1 November 2013
How to Cite
Brem, S., Meyers, C. A., Palmer, G., Booth-Jones, M., Jain, S. and Ewend, M. G. (2013), Preservation of neurocognitive function and local control of 1 to 3 brain metastases treated with surgery and carmustine wafers. Cancer, 119: 3830–3838. doi: 10.1002/cncr.28307
We thank Dr. Robert Wilkins for his review of the article.
- Issue published online: 18 OCT 2013
- Article first published online: 23 AUG 2013
- Manuscript Accepted: 11 JUL 2013
- Manuscript Received: 17 JUN 2013
- brain metastases;
- carmustine wafers;
- neurocognitive function;
- stereotactic radiosurgery;
- whole brain radiotherapy
Neurosurgical resection and whole-brain radiation therapy (WBRT) are accepted treatments for single and oligometastatic cancer to the brain. To avoid the decline in neurocognitive function (NCF) linked to WBRT, the authors conducted a prospective, multicenter, phase 2 study to determine whether surgery and carmustine wafers (CW), while deferring WBRT, could preserve NCF and achieve local control (LC).
NCF and LC were measured in 59 patients who underwent resection and received CW for a single (83%) or dominant (oligometastatic, 2 to 3 lesions) metastasis and received stereotactic radiosurgery (SRS) for tiny nodules not treated with resection plus CW. Preservation of NCF was defined as an improvement or a decline ≤1 standard deviation from baseline in 3 domains: memory, executive function, and fine motor skills, evaluated at 2-month intervals.
Significant improvements in executive function and memory occurred throughout the 1-year follow-up. Preservation or improvement of NCF occurred in all 3 domains for the majority of patients at each of the 2-month intervals. NCF declined in only 1 patient. The chemowafers were well tolerated, and serious adverse events were reversible. There was local recurrence in 28% of the patients at 1-year follow-up.
Patients with brain metastases had improvements in their cognitive trajectory, especially memory and executive function, after treatment with resection plus CW. The rate of LC (78%) was comparable to historic rates of surgery with WBRT and superior to reports of WBRT alone. For patients who undergo resection for symptomatic or large-volume metastasis or for tissue diagnosis, the addition of CW can be considered as an option. Cancer 2013;119:3830–3838. © 2013 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society.