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Whole Brain Radiation Increases Risk of Learning and Memory Problems for Cancer Patients E-mail
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braincancerCancer patients with tumors that have spread to the brain (brain metastases) who undergo stereotactic radiosurgery (SRS) and whole brain radiation have more than double the risk of developing learning and memory problems, compared to those who only have stereotactic radiosurgery, according to a randomized study presented September 22, 2008, at the American Society for Therapeutic Radiology and Oncology's 50th Annual Meeting in Boston.

"Results of this study show that initial stereotactic radiosurgery alone, coupled with close observation, could become the standard of care for patients newly diagnosed with brain metastases to best preserve their neurocognitive function," Eric L. Chang, M.D., lead author of the study and a radiation oncologist at M.D. Anderson Cancer Center in Houston, said. "Results of this study could change the practice of how brain metastases are managed in the United States."

Stereotactic radiosurgery is a specialized type of external beam radiation therapy that pinpoints high doses of radiation directly on the cancer in a shorter amount of time than traditional treatments (one day, instead of several weeks). Whole brain radiation therapy treats the visible lumps of the cancer and the invisible tumor deposits that are so small they may not be seen on even a sensitive imaging test. Therefore, the entire brain is treated to try to stop the spread of the tumors.

The study involved 58 patients who were newly diagnosed with one, two or three brain metastases and were randomized to receive stereotactic radiosurgery combined with whole brain radiation or stereotactic radiosurgery alone from January 2001 to September 2007.

The trial was halted after interim results showed that patients who received both stereotactic radiosurgery and whole brain radiation had a 49 percent decline in learning and memory functioning at four months, compared to patients who underwent stereotactic radiosurgery alone and who experienced a 23 percent decline in neurocognitive functioning. Neurocognitive outcome was measured by the ability of patients to immediately recall a list of 12 words after three attempts. For patients who received initial whole brain irradiation, nearly half of the patients lost the ability to recall five words from the same list over three attempts, compared to before they received the treatment.

Source: "Phase III Randomized Clinical Trial of Radiosurgery with or without Whole Brain Irradiation in Patients Newly Diagnosed with 1 to 3 Brain Metastases," 

About Brain Cancer

All brain cancers are life threatening (malignant) because they have an aggressive and invasive nature. In the United States, the annual incidence of brain cancer generally is 15-20 cases per 100,000 people. Brain cancer is the leading cause of cancer-related death in patients younger than age 35.

There are two types of brain tumors: primary brain tumors that originate in the brain and metastatic (secondary) brain tumors that originate from cancer cells that have migrated from other parts of the body.

Primary brain cancer rarely spreads beyond the central nervous system, and death results from uncontrolled tumor growth within the limited space of the skull. Metastatic brain cancer indicates advanced disease and has a poor prognosis.

Exposure to vinyl chloride is an environmental risk factor for brain cancer. Vinyl chloride is a carcinogen, that is, a cancer-causing substance. It is used in manufacturing plastic products and is present in tobacco smoke.

Aside from a known association with exposure to vinyl chloride, there are no known chemical or environmental agents that lead to the development of brain tumors. Most incidents of brain cancer involve genetic mutations and deletions of tumor suppressor genes (i.e., genes that suppress the development of malignant cells). Studies show that people with a history of melanoma, lung cancer, breast cancer, colon cancer, or kidney cancer are at risk for secondary brain cancer.

Manufacturing and chemical plants may release vinyl chloride into the air or water, and it may leak into the environment as a result of improper disposal. People who work in these plants or live in close proximity to them have an increased risk for brain cancer.

 

 

About Cancer

Cancer (medical term: malignant neoplasm) is the general name for a group of more than 100 diseases in which a group of cells display uncontrolled growth (division beyond the normal limits), invasion (intrusion on and destruction of adjacent tissues), and sometimes metastasis (spread to other locations in the body via lymph or blood). These three malignant properties of cancers differentiate them from benign tumors, which are self-limited, do not invade or metastasize. Most cancers form a tumor but some, like leukemia, do not. The branch of medicine concerned with the study, diagnosis, treatment, and prevention of cancer is oncology.

Cancer cells can spread to other parts of the body through the blood and lymph systems. Most cancers are named for the organ or type of cell in which they start - for example, cancer that begins in the colon is called colon cancer; cancer that begins in basal cells of the skin is called basal cell carcinoma.

Cancer types can be grouped into broader categories. The main categories of cancer include:
  • Carcinoma - a cancer which is derived from the lining cells, or epithelium, of an organ. There are 4 major types of epithelium in the body (Glandular, squamous, transitional, and pseudostratified). Some types are only found in a few select organs such as the lung (pseudostratified) or urinary bladder (transitional).  Carcinomas can arise from any of these epithelial types. For example, breast carcinoma is most commonly derived from the lining cells of the milk producing glands. A carcinoma with a glandular growth pattern is an adenocarcinoma.  Common adenocarcinomas include prostate, colon, and breast.  A carcinoma with a growth pattern resembling the squamous lining cells is termed a squamous cell carcinoma.  Common squamous cell carcinomas are found in the esophagus and skin.  However, any of these organs may have either type of carcinoma arising from it, although these latter diagnoses are exceedingly rare.
  • Central nervous system cancers - cancers that begin in the tissues of the brain and spinal cord.
  • Leukemia - cancer that starts in blood-forming tissue such as the bone marrow and causes large numbers of abnormal blood cells to be produced and enter the blood.
  • Lymphoma - a cancer derived from the white blood cells that are present in the lymphoid tissues of the body.  These sites most commonly include the lymph nodes and spleen. However, lymphomas may arise from any organ and body site.
  • Sarcoma - cancer that begins in bone, cartilage, fat, muscle, blood vessels, or other connective or supportive tissue.

Today, millions of people are living with cancer or have had cancer. The risk of developing most types of cancer can be reduced by changes in a person's lifestyle, for example, by quitting smoking, limiting time in the sun, being physically active, and eating a better diet. Half of all men and one-third of all women in the US will develop cancer during their lifetimes.

Although doctors often cannot explain why one person develops cancer and another does not, research shows that certain risk factors increase the chance that a person will develop cancer. Nearly all cancers are caused by abnormalities in the genetic material of the transformed cells. These abnormalities may be due to the effects of carcinogens, such as tobacco smoke, radiation, chemicals, or viruses, bacteria, and certain hormones. Other cancer-promoting genetic abnormalities may be randomly acquired through errors in DNA replication, or are inherited, and thus present in all cells from birth.  Other common risk factors for cancer include:
  • Growing Older
  • Family history of cancer
  • Poor diet, lack of physical activity, or being overweight
  • Alcohol
 
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