Oncology · Neurology · 7 h ago
Unilateral and bilateral hippocampal avoidance show equivalent verbal-memory outcomes
A randomized, single-blind phase 2 equivalence trial compared unilateral (left-sided) with bilateral hippocampal-avoidance whole-brain radiotherapy (HA-WBRT), both with memantine, in 73 patients with brain metastases. At six months, verbal-memory decline met the prespecified equivalence criterion; the authors say the findings need validation.
- Verbal-memory decline met the prespecified equivalence criterion.
- The trial included 73 patients with brain metastases.
- Non-verbal memory was not assessed; validation is needed.
The trial assigned 73 patients with brain metastases to unilateral (left) or bilateral HA-WBRT, delivered as 30 Gy in 10 fractions, with concurrent memantine. The primary endpoint was relative change in Hopkins Verbal Learning Test-Revised memory score from baseline to six months. Equivalence was defined as a between-group difference whose 90% confidence interval fell within ±15 percentage points.
At six months, mean relative verbal-memory decline was 4.75% with unilateral avoidance and 5.05% with bilateral avoidance. The between-group difference was −0.31% (90% CI, −12.02% to 11.40%), meeting the equivalence criterion. Brain progression-free survival, overall survival, acute toxicity and six-month neurocognitive failure were also reported as similar between groups. Global health status appeared more stable with unilateral avoidance.
The findings suggest unilateral left-sided avoidance may be an alternative when bilateral avoidance is challenging, but the phase 2 results require validation. The study did not assess non-verbal memory, and its 73-patient sample limits the strength and generalizability of conclusions about comparative outcomes.
In practice
For patients with brain metastases receiving HA-WBRT and memantine, this randomized phase 2 trial found that left-sided unilateral avoidance met the prespecified equivalence criterion for six-month verbal-memory decline compared with bilateral avoidance. The results may be relevant when bilateral hippocampal avoidance is difficult to achieve, but they do not establish a change in standard practice: only 73 patients were enrolled, follow-up was limited, the trial requires validation, and non-verbal memory was not assessed.
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Neuro-Oncology: Unilateral vs Bilateral Hippocampal Avoidance During WBRT With Memantine for Brain Metastases: A Randomized Single-Blind Phase 2 Clinical Trial ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.