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Clinical Trials of Radiation Therapy

Modified whole brain radiotherapy: Hippocampal-avoidance radiotherapy 
This is a randomized phase lll trial. All patients will receive memantine hydrochoride ( Namenda ) which is a drug shown to improve memory and cognition when given to patients together with whole-brain radiotherapy. Then patients will be randomized to receive regular WBRT or WBRT that does not radiate the hippocampal region of the brain. The hippocampal region of the brain plays an important role in memory and understanding and shielding it from radiation may improve memory and cognition after WBRT. However, it is not known whether not radiating the hippocampal region might increase the risk for recurrences in the brain. Patients must not have had prior WBRT and brain metastases must be 5mm or more from the hippocampus. Patients with leptomeningeal disease do not qualify.
This two-arm randomized trial is being conducted in Germany.  It compares the cognitive function (understanding, learning, and memory) of WBRT versus WBRT that avoids radiation to the hippocampal region of the brain, where memory and cognition are stored. The intent is to study and compare both arms in terms of cognition, recurrence in the brain, and overall survival. It is not known if avoiding the hippocampal region of the brain may increase the chance of recurrence in that area.
This phase II single arm study is being conducted in Taiwan. All patients will receive WBRT that avoids the hippocampal region of the brain, where memory and cognition are stored, to see if shielding it from radiation improves cognition and memory. No brain metastases can be larger than 4 cm and patients can't have leptomeningeal disease.
This phase ll randomized trial is taking place in Taiwan. Patients in the trial will receive either conformational WBRT that avoids the hippocampal region of the brain, where memory and cognition are stored, or conformational WBRT that includes the hippocampus. All brain metastases must be at least 5cm from the hippocampus. Patients with leptomeningeal disease are excluded.
This is a phase ll trial looking at a different type of whole brain radiotherapy known as IMRT, which delivers higher doses of radiation to brain metastases while delivering a lower dose of radiation to the rest of the brain. The hope is that the part of the brain without clinical brain metastases will not need as high a dose as the areas that have brain metastases, and that delivering less radiation will reduce toxicity and cognitive side effects.
Clinical Trials for Radiation-Caused Necrosis
To see if this imaging technique can differentiate between recurring brain metastases and radiation necrosis.