{'fraction_non_alphanumeric': 0.046153846153846156, 'fraction_numerical': 0.024615384615384615, 'mean_word_length': 4.721407624633431, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Hippocampal Avoidance Whole-brain Radiotherapy without Memantine in Preserving Neurocognitive Function for Brain Metastases: A Phase II Blinded Randomized Trial.

BACKGROUND
Hippocampal avoidance whole-brain radiotherapy (HA-WBRT) shows potential for neurocognitive preservation. This study aimed to evaluate whether HA-WBRT or conformal WBRT (C-WBRT) is better for preserving neurocognitive function.


METHODS
This single-blinded randomized phase II trial enrolled patients with brain metastases and randomly assigned to receive HA-WBRT or C-WBRT. Primary end point is the decline of Hopkins Verbal Learning Test-Revised (HVLT-R) Delayed Recall at 4 months after treatment. Neurocognitive function tests were analyzed with a mixed effect model. Brain progression free survival (BPFS) and overall survival (OS) were estimated using the Kaplan-Meier method.


RESULTS
From March 2015 to December 2018, seventy patients were randomized to yield a total cohort of 65 evaluable patients (33 in the HA-WBRT arm and 32 in the C-WBRT arm) with a median follow-up of 12.4 months.　No differences in baseline neurocognitive function existed between the two arms. The mean change of HVLT-R delayed recall at 4 months was -8.8% in the HA-WBRT arm, and +3.8% in the C-WBRT arm (p=0.31). At six months, patients receiving HA-WBRT showed favorable perpetuation of HVLT-R total recall (mean difference = 2.60, p=0.079) and significantly better preservation of the HVLT-R recognition-discrimination index (mean difference = 1.78, p=0.019) and memory score (mean difference = 4.38, p=0.020) compared with patients undergoing C-WBRT. There were no differences in TMT part A, part B, or the COWA test between the two arms at any time point. There were no differences in BPFS or OS between arms as well.


CONCLUSIONS
Patients receiving HA-WBRT without memantine showed better preservation in memory at 6-month follow-up, but not in verbal fluency or executive function.