New surgical approach may improve cognitive function in patients with brain cancer

September 26, 2013

A new approach to treating cancer that has spread to the brain is able to preserve and, in some cases, improve cognitive function in patients, while achieving local control of tumor progression. A study led by researchers with the Perelman School of Medicine at the University of Pennsylvania found that 98 percent of patients who deferred whole brain radiation therapy and had chemotherapeutic wafers placed around the areas where metastatic tumors in the brain had been surgically removed showed preserved cognitive function in one or more of three domains; 65 percent showed preservation in all areas tested: memory, executive function, and fine motor skills. The study, published online in Cancer, demonstrated improvements in cognitive function, particularly in executive function and memory, which were observed in more than 40 percent of patients. In the fine motor movement category, 50 percent of patients showed improvements.

Brain metastases affect between 25 and 45 percent of all cancer patients. Whole therapy is often used to control recurrence and spreading of metastases in the brain, but it causes in more than a third of patients and fails to improve independent function or prolong overall survival. Newer treatments, such as stereotactic radiation (e.g. Cyberknife or Gamma knife) and chemotherapeutic wafers (Gliadel wafers) aim to treat metastases or recurrences locally while preserving cognitive function. These new approaches preserve white matter integrity; previous studies have looked at current using advanced neuroimaging, such as (DTI or diffusion tractography), that enable surgeons to remove the tumor while sparing the fiber tracts that mediate language, motor skills, and other key functions.

"While not denying the value of whole brain for select patients, the current study supports the growing trend for some patients to have surgery and local therapy to the tumor bed, via stereotactic radiosurgery or chemowafers," said lead author Steven Brem, MD, professor of Neurosurgery at the Perelman School of Medicine. "We know that about half of patients with metastatic brain cancer go on to develop a new, separate brain metastasis, which can be detected by using surveillance MRI every 2 to 3 months. Some patients can go for years with normal brain function without risking the toxicity of whole brain radiation."

The study – by a team of researchers from Perelman School of Medicine at the University of Pennsylvania, the University of North Carolina, MD Anderson Cancer Center, and Moffitt Cancer Center – followed 59 patients with up to three who had received surgery and chemowafers wafers lining the tumor cavity. Of the 54 patients who followed the post-surgical protocol, 63 percent of patients had preserved fine motor coordination (34 of 54 patients), 72 percent had preserved executive function (39 of 54), and 69 percent had preserved memory (37 of 54), including 48 percent that saw an improvement in memory function (26 of 54). Only one patient (2 percent) had a decrease in all three cognition domains. Local tumor recurrences occurred in 28 percent of patients evaluated at the end of the one-year study. Distant recurrences were found in 48 percent of patients, with more than half of recurrences happening within four months of the treatment.

"We will continue to try to find interventions that preserve function while preserving or increasing the quality life for patients with cancer that spreads to their brain," said Dr. Brem, noting that further studies comparing treatment options are needed to determine the optimal treatment strategy.

The toxicity profile was that expected for a patient population with advanced cancer metastatic to the brain. Serious adverse events were reported in 40 of 59 patients; complications related to the chemowafers were resolved with medical or surgical intervention. Nine patients died during the study, one from a neurologic cause and eight as a result of their primary cancers.

Explore further: Adult cancer patients younger than 50 with limited brain mets have improved OS after SRS alone

Related Stories

Adult cancer patients younger than 50 with limited brain mets have improved OS after SRS alone

September 23, 2013
When treated with stereotactic radiosurgery (SRS), that is not combined with whole brain radiotherapy (WBRT), adult brain cancer patients who were 50 years old and younger were found to have improved survival, according to ...

Protecting specific area of the brain during radiation therapy substantially reduces memory loss

September 23, 2013
Protecting the stem cells that reside in and around the hippocampus – a C-shaped area in the temporal lobe on both sides of the brain associated with the ability to form and store memories – substantially reduces the ...

Encouraging outcomes for pediatric brain tumor patients treated with proton therapy

September 23, 2013
When used to treat pediatric patients with intracranial malignant tumors, proton therapy may limit the toxicity of radiation therapy while preserving tumor control, according to research presented today at the American Society ...

Cognitive rehabilitation improves brain function in cancer survivors

September 20, 2013
Cancer survivors who experience memory and thinking problems may benefit from cognitive rehabilitation, according to a new study led by Monique Cherrier, a UW associate professor of psychiatry and behavioral sciences.

Carbon ion radiotherapy safe and effective for treating inoperable spinal tumors

August 12, 2013
A new analysis has found that a type of radiation therapy called carbon ion radiotherapy can control cancer growth and prolong survival in patients with spinal tumors. Published early online in Cancer, a peer-reviewed journal ...

'Toxicity map' of brain may help protect cognition for cancer patients

March 20, 2013
New research from Wake Forest Baptist Medical Center is giving radiation oncologists who treat brain tumors a better understanding of how to preserve the brain's functions while still killing cancer.

Recommended for you

Long-sought mechanism of metastasis is discovered in pancreatic cancer

July 27, 2017
Cells, just like people, have memories. They retain molecular markers that at the beginning of their existence helped guide their development. Cells that become cancerous may be making use of these early memories to power ...

Researchers release first draft of a genome-wide cancer 'dependency map'

July 27, 2017
In one of the largest efforts to build a comprehensive catalog of genetic vulnerabilities in cancer, researchers from the Broad Institute of MIT and Harvard and Dana-Farber Cancer Institute have identified more than 760 genes ...

Cancer-death button gets jammed by gut bacterium

July 27, 2017
Researchers at Michigan Medicine and in China showed that a type of bacterium is associated with the recurrence of colorectal cancer and poor outcomes. They found that Fusobacterium nucleatum in the gut can stop chemotherapy ...

Manmade peptides reduce breast cancer's spread

July 27, 2017
Manmade peptides that directly disrupt the inner workings of a gene known to support cancer's spread significantly reduce metastasis in a mouse model of breast cancer, scientists say.

Blocking the back-door that cancer cells use to escape death by radiotherapy

July 27, 2017
A natural healing mechanism of the body may be reducing the efficiency of radiotherapy in breast cancer patients, according to a new study.

Glowing tumor technology helps surgeons remove hidden cancer cells

July 27, 2017
Surgeons were able to identify and remove a greater number of cancerous nodules from lung cancer patients when combining intraoperative molecular imaging (IMI) - through the use of a contrast agent that makes tumor cells ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.