Generously funded by an anonymous research fund

Alan Nichol – BC Cancer

Project Title: “The Relationship between Magnetic Resonance Imaging White Matter Hyper intensities and Cognition after Whole Brain Radiotherapy”

Description of Project:

Patients with brain metastases have a number of treatment options, including surgery, stereotactic radiosurgery, whole brain radiotherapy (WBRT), systemic therapy and observation. WBRT is often used because it is effective, quick to organize and generally well tolerated. However, in some patients, it causes memory and/or cognitive impairment. Our preliminary work, using the pre-treatment magnetic resonance imaging in 46 patients, showed that age and the amount of white matter hyperintensities (regions of age-related degeneration) in the brain before WBRT predicted for worse neuro-cognitive outcomes after WBRT. We are collaborating with the Alliance for Clinical Trials in Oncology, which manages the data from two completed randomized clinical trials of WBRT and stereotactic radiosurgery. They have agreed to provide the pre-treatment imaging and post-treatment neurocognitive testing results on 417 patients, so we can investigate the relationship between the amount of white matter hyperintensities in the brain before WBRT and neuro-cognitive outcomes after WBRT.

Knowing which patients are most likely to experience neuro-cognitive impairment will help clinicians to individualize the management of brain metastases. Oncologists can advise patients at high risk of neuro-cognitive toxicity to have surgery, stereotactic radiosurgery, systemic therapy or observation, instead of WBRT, for brain metastases.

What receiving this award means:

This Brain Tumour Foundation of Canada grant will allow us to extend the work started on BC Cancer suggesting that white matter hyperintensities on pre-treatment MRI predict for poor cognitive outcomes after whole brain radiotherapy for brain metastases. We will be able to obtain pre-treatment MRIs and post-treatment cognitive outcomes from two completed randomized clinical trials conducted by the Alliance for Clinical Trials in Oncology. With these data, we will be able to confirm whether white matter hyperintensities on patients’ pre-treatment imaging predict for poor cognitive outcomes after whole brain radiotherapy. This information will help radiation oncologists choose the optimal radiotherapy for brain metastases for their patients.

Midpoint Report – March 2022