Cancer patients who experience cognitive decline following radiation treatment for brain metastases may see significant recovery in neurocognitive function, according to a new study by researchers at the University of Maryland Greenebaum Comprehensive Cancer Center (UMGCCC). The analysis of 288 patients across three Phase III clinical trials, presented at the American Society for Radiation Oncology (ASTRO) annual meeting, found that nearly 40 percent of patients fully recovered cognitive abilities within six months. This offers new hope and guidance for managing treatment expectations and improving patient quality of life.
Targeted Radiation Boosts Recovery
The study, led by Hua-Ren Ryan Cherng, MD, a radiation oncology resident at UMGCCC, also highlighted that patients who received highly targeted radiation treatments, such as high-dose stereotactic radiosurgery or hippocampus-sparing whole-brain radiation, were more likely to recover cognitive function compared to those treated with standard whole-brain radiation. Cognitive recovery was defined as achieving scores within the normal range on a battery of neurocognitive tests.
"No longer should we be viewing cognitive dysfunction as a permanent endpoint for patients," Dr. Cherng stated. "It is not uncommon for patients to experience cognitive issues following radiation therapy, especially whole-brain radiation, but we didn’t know how they would fare long-term. Now we have data that show that they can get better within months – with no symptoms – and sustain that recovery over time."
Impact on Patient Care and Counseling
Brain metastases, which affect approximately 200,000 people in the U.S. annually, often necessitate radiation therapy. While effective in managing the spread of cancer, radiation can lead to cognitive side effects that significantly impact patients' quality of life. The new findings suggest that these effects are not necessarily permanent, providing a basis for more optimistic patient counseling and treatment planning.
"With more targeted radiation, systemic therapies and earlier detection, these patients are living longer, and cognitive side effects are a major quality-of-life concern for them," Dr. Cherng noted. "They still want to share memories and make new memories with their loved ones. Cognition is a critical part of their lives."
Detailed Findings from Clinical Trials
The researchers analyzed long-term cognitive testing data from three clinical trials conducted by the North Central Cancer Trials Group and NRG Oncology. Of the 288 patients who experienced cognitive problems, 38 percent fully recovered at six months, and 42 percent at one year. Furthermore, 73 percent showed improvement on cognitive tests at six months, and 76 percent at one year, even if they had not achieved full recovery. A subset of patients followed for two years maintained cognitive recovery in two-thirds of cases.
Additional Research on Clinical Trial Participation
In a related study presented at the ASTRO meeting, researchers explored factors influencing Black patients' participation in cancer-related clinical trials. The study revealed that Black patients were more likely to express beliefs related to faith and were more likely to harbor mistrust due to historical injustices. These findings underscore the importance of addressing these concerns during the recruitment process to improve representation in clinical trials.
"Our research has identified some really important themes that should be discussed with patients as part of the recruitment process, such as spirituality or faith, as well as recognizing the elephant in the room that is a justifiable mistrust stemming from structural racism and historical practices in clinical trial programs," said Charlyn Gomez, the study’s lead author.
