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CogState computerized memory tests in patients with brain metastases: secondary endpoint results of NRG Oncology RTOG 0933

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Abstract

Whole brain radiotherapy (WBRT) is associated with memory dysfunction. As part of NRG Oncology RTOG 0933, a phase II study of WBRT for brain metastases that conformally avoided the hippocampal stem cell compartment (HA-WBRT), memory was assessed pre- and post-HA-WBRT using both traditional and computerized memory tests. We examined whether the computerized tests yielded similar findings and might serve as possible alternatives for assessment of memory in multi-institution clinical trials. Adult patients with brain metastases received HA-WBRT to 30 Gy in ten fractions and completed Hopkins Verbal Learning Test-Revised (HVLT-R), CogState International Shopping List Test (ISLT) and One Card Learning Test (OCLT), at baseline, 2 and 4 months. Tests’ completion rates were 52–53 % at 2 months and 34–42 % at 4 months. All baseline correlations between HVLT-R and CogState tests were significant (p ≤ 0.003). At baseline, both CogState tests and one component of HVLT-R differentiated those who were alive at 6 months and those who had died (p ≤ 0.01). At 4 months, mean relative decline was 7.0 % for HVLT-R Delayed Recall and 18.0 % for ISLT Delayed Recall. OCLT showed an 8.0 % increase. A reliable change index found no significant changes from baseline to 2 and 4 months for ISLT Delayed Recall (z = −0.40, p = 0.34; z = −0.68, p = 0.25) or OCLT (z = 0.15, p = 0.56; z = 0.41, p = 0.66). Study findings support the possibility that hippocampal avoidance may be associated with preservation of memory test performance, and that these computerized tests also may be useful and valid memory assessments in multi-institution adult brain tumor trials.

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Acknowledgments

This study was presented in abstract form at the 2014 meeting (ESTRO 33) of The European Society for Radiotherapy & Oncology.

Funding

The study was approved by the National Cancer Institute (NCI) and supported by Radiation Therapy Oncology Group (RTOG) grant U10 CA21661, NRG Oncology Operations 1U10CA180868-01, NRG Oncology SDMC 1U10CA180822-01, Community Clinical Oncology Program Network grant U10 CA37422 and Imaging and Radiation Oncology Core 1U24CA180803-01 from the NCI. This manuscript’s contents are the sole responsibility of the authors and do not necessarily represent the official views of the NCI.

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Authors and Affiliations

  1. Neurosciences Institute, Intermountain Medical Center, 5171 Cottonwood Street, 8th Floor, Murray, UT, 84107, USA

    Chip Caine

  2. University of Phoenix, Utah Campus, 5373 S 360 W, Salt Lake City, UT, 84123, USA

    Chip Caine

  3. NRG Oncology Statistics and Data Management Center, 1818 Market Street, Suite 1600, Philadelphia, PA, 19103, USA

    Snehal Deshmukh

  4. Northwestern Medicine Cancer Center, Warrenville and Northwestern Chicago Proton Center, 4455 Weaver Parkway, Warrenville, IL, 60555, USA

    Vinai Gondi

  5. Department of Human Oncology, UW-Madison School of Medicine and Public Health, 600 Highland Avenue, K4/334-3684, Madison, WI, 53792, USA

    Vinai Gondi

  6. Department of Radiation Oncology, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, 21201, USA

    Minesh Mehta & Howard Rowley

  7. Montefiore Medical Center and Albert Einstein College of Medicine of Yeshiva University, 1300 Morris Park Avenue, Bronx, NY, 10461, USA

    Wolfgang Tomé

  8. Institute of Radiotherapy, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 64239, Tel Aviv, Israel

    Benjamin W. Corn & Andrew Kanner

  9. Saskatoon Cancer Centre, 20 Campus Drive, Saskatoon, SK, S7N 4H4, Canada

    Vijayananda Kundapur

  10. Main Line CCOP, Lankenau Medical Center, 100 Lancaster Ave: 4 MSB, Suite 4430, Wynnewood, PA, 19096, USA

    Albert DeNittis

  11. Juravinski Cancer Centre, McMaster University-Hamilton, 699 Concession St., Hamilton, ON, L8V 5C2, Canada

    Jeffrey Noah Greenspoon

  12. The Chester County Hospital, 440 East Marshall Street, Suite 201, West Chester, PA, 19380, USA

    Andre A. Konski

  13. Department of Oncology, London Regional Cancer Program, 790 Commissioners Road East, London, ON, N6A 4L6, Canada

    Glenn S. Bauman

  14. Christiana Care Health Services, CCOP, Helen F. Graham Cancer Center & Research Institute, 4701 Ogletown-Stanton Rd., S-1110, Newark, DE, 19713, USA

    Adam Raben

  15. Bodine Center, Thomas Jefferson University Hospital, 111 South 11th Street, Philadelphia, PA, 19107, USA

    Wenyin Shi

  16. Willamette Valley Cancer Institute, 520 Country Club Road, Eugene, OR, 97401, USA

    Merideth Wendland

  17. Department of Radiation Oncology, Boston Medical Center MBCCOP, 830 Harrison Avenue, Boston, MA, 02118, USA

    Lisa Kachnic

Authors
  1. Chip Caine
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  2. Snehal Deshmukh
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  3. Vinai Gondi
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  4. Minesh Mehta
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  5. Wolfgang Tomé
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  9. Vijayananda Kundapur
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  13. Glenn S. Bauman
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  14. Adam Raben
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  15. Wenyin Shi
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  17. Lisa Kachnic
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Corresponding author

Correspondence to Chip Caine.

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Conflict of Interest

Wolfgang A. Tomé serves on the scientific advisory board of View Ray Inc.; holds patents through Wisconsin Alumni Research Foundation (WARF); and has received research funding from NIH, Philips Medical System and Accuray. Minesh Mehta has served as a consultant for Abbott, BMS, Celldex, Elekta, Novelos, Novocure, Phillips and Roche; holds stock options in Pharmacyclics; has served as a speaker for Defined Health, IME and Serono; and has research funding from Novocure. Wenyin Shi performed consulting work for Elekta and Varian. None of these activities is related to this protocol.

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Caine, C., Deshmukh, S., Gondi, V. et al. CogState computerized memory tests in patients with brain metastases: secondary endpoint results of NRG Oncology RTOG 0933. J Neurooncol 126, 327–336 (2016). https://doi.org/10.1007/s11060-015-1971-2

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