Neuropsychological testing and biomarkers in the management of brain metastases.
Prognosis for patients with brain metastasis remains poor. Whole brain radiation therapy is the conventional treatment option; it can improve neurological symptoms, prevent and improve tumor associated neurocognitive decline, and prevents death from neurologic causes. In addition to whole brain radiation therapy, stereotactic radiosurgery, neurosurgery and chemotherapy also are used in the management of brain metastases. Radiosensitizers are now currently being investigated as potential treatment options. All of these treatment modalities carry a risk of central nervous system (CNS) toxicity that can lead to neurocognitive impairment in long term survivors. Neuropsychological testing and biomarkers are potential ways of measuring and better understanding CNS toxicity. These tools may help optimize current therapies and develop new treatments for these patients. This article will review the current management of brain metastases, summarize the data on the CNS effects associated with brain metastases and whole brain radiation therapy in these patients, discuss the use of neuropsychological tests as outcome measures in clinical trials evaluating treatments for brain metastases, and give an overview of the potential of biomarker development in brain metastases research.
Baschnagel
Andrew
A
Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, 9000 Rockville Pike, Building 10-CRC, Room B2-3561, Bethesda, Maryland, 20892, USA. amb26@buffalo.edu
Wolters
Pamela L
PL
Camphausen
Kevin
K
D000368:Aged; D014408:Biomarkers, Tumor / Q000378:metabolism*; D001932:Brain Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism / Q000523:psychology*; D002490:Central Nervous System / Q000187:drug effects / Q000473:pathology; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009483:Neuropsychological Tests; D011379:Prognosis; D016634:Radiosurgery; D012107:Research Design; D016896:Treatment Outcome
D014408:Biomarkers, Tumor
Cancer. 1981 Jul 15;48(2):384-94
7237407
Clin Chim Acta. 1989 Jul 31;183(1):13-31
2548772
J Neurooncol. 1994;19(2):149-54
7964990
Int J Radiat Oncol Biol Phys. 2001 Oct 1;51(2):426-34
11567817
Cancer. 1965 Mar;18:298-306
14264031
J Clin Oncol. 2004 Jan 1;22(1):157-65
14701778
Strahlenther Onkol. 1994 Mar;170(3):155-61
8160096
J Psychiatr Res. 1975 Nov;12(3):189-98
1202204
Int J Radiat Oncol Biol Phys. 2008 May 1;71(1):64-70
18406884
N Engl J Med. 1990 Feb 22;322(8):494-500
2405271
Md State Med J. 1965 Feb;14:61-5
14258950
Int J Radiat Oncol Biol Phys. 1999 Mar 1;43(4):795-803
10098435
Int J Radiat Oncol Biol Phys. 1995 Oct 15;33(3):619-26
7558951
Radiat Res. 2000 Apr;153(4):357-70
10798963
Cancer Res. 2003 Jul 15;63(14):4021-7
12874001
Neurosurgery. 2007 Feb;60(2):277-83; discussion 283-4
17290178
Ment Retard Dev Disabil Res Rev. 2006;12(3):184-91
17061287
J Clin Oncol. 2005 Dec 1;23(34):8870-6
16314647
J Am Acad Dermatol. 1999 Dec;41(6):962-9
10570381
Br J Cancer. 2004 May 4;90(9):1691-6
15150608
Ann Neurol. 1980 Jun;7(6):529-41
7436358
Cancer Res. 1996 Jan 1;56(1):172-81
8548760
Br J Cancer. 1997;76(8):1041-5
9376264
JAMA. 2006 Jun 7;295(21):2483-91
16757720
Lancet. 2004 May 22;363(9422):1665-72
15158627
J Clin Oncol. 2006 Mar 20;24(9):1415-20
16549835
J Clin Oncol. 2004 Feb 1;22(3):499-506
14752073
Strahlenther Onkol. 1986 Mar;162(3):157-61
3515602
Cancer. 2005 Aug 15;104(4):817-24
15971200
Int J Radiat Oncol Biol Phys. 1981 Dec;7(12):1633-8
6174490
Int J Radiat Oncol Biol Phys. 1991 Jan;20(1):53-8
1993631
Int J Radiat Oncol Biol Phys. 2008 Feb 1;70(2):510-4
17931798
J Clin Oncol. 2000 Apr;18(7):1423-31
10735889
Technol Cancer Res Treat. 2003 Apr;2(2):111-5
12680791
J Clin Oncol. 2002 Sep 1;20(17):3644-50
12202665
Int J Radiat Oncol Biol Phys. 1980 Jan;6(1):1-9
6154024
J Clin Oncol. 2000 Feb;18(3):646-50
10653880
J Neurosurg. 2002 Dec;97(5 Suppl):499-506
12507085
Int J Radiat Oncol Biol Phys. 1997 Mar 1;37(4):745-51
9128946
J Clin Oncol. 2003 Jul 1;21(13):2519-24
12829670
Stroke. 2000 Oct;31(10):2325-9
11022058
Cancer. 1996 Oct 1;78(7):1470-6
8839553
Lancet. 1997 Jan 11;349(9045):79-83
8996418
J Clin Oncol. 2004 Jun 1;22(11):2233-9
15169812
Int J Radiat Oncol Biol Phys. 2004 Apr 1;58(5):1346-52
15050309
J Clin Oncol. 2004 Feb 15;22(4):706-13
14966095
Cancer. 1995 Mar 1;75(5):1151-61
7850714
Lancet. 2002 Nov 2;360(9343):1361-8
12423981
Int J Radiat Oncol Biol Phys. 1981 Jul;7(7):891-5
6171553
J Neurooncol. 1984;2(4):325-30
6397578
Int J Radiat Oncol Biol Phys. 1977 Nov-Dec;2(11-12):1091-4
74375
Stroke. 2001 May;32(5):1154-61
11340225
J Clin Oncol. 1998 Jul;16(7):2522-7
9667273
J Clin Oncol. 2003 Jun 15;21(12):2364-71
12805339
Int J Radiat Oncol Biol Phys. 1997 Oct 1;39(3):571-4
9336134
Lancet Neurol. 2008 Jun;7(6):548-60
18485318
Neurology. 1989 Jun;39(6):789-96
2725874
Med Clin North Am. 1963 Nov;47:1647-58
14078168
Int J Radiat Oncol Biol Phys. 2007 Aug 1;68(5):1388-95
17674975
Int J Radiat Oncol Biol Phys. 2000 Aug 1;48(1):59-64
10924972
Neuro Oncol. 2003 Apr;5(2):89-95
12672280
J Clin Oncol. 2007 Apr 1;25(10):1260-6
17401015
Int J Radiat Oncol Biol Phys. 2001 Mar 15;49(4):1015-21
11240242
J Clin Oncol. 2006 Jan 1;24(1):106-14
16314619
Cancer. 2003 Jun 1;97(11):2806-13
12767094
Clin Cancer Res. 2008 Feb 1;14(3):931-8
18245557
Stroke. 2002 Apr;33(4):982-7
11935048
Mol Pharmacol. 1989 Jul;36(1):106-12
2568579
Neurosurg Clin N Am. 1996 Jul;7(3):337-44
8823767
Br J Cancer. 2001 Apr 6;84(7):903-9
11286469
J Neurol Neurosurg Psychiatry. 2003 Mar;74(3):322-5
12588916
Am J Clin Oncol. 2003 Jun;26(3):273-9
12796600
Int J Radiat Oncol Biol Phys. 1995 Mar 30;31(5):1093-112
7677836
Int J Radiat Oncol Biol Phys. 2008 May 1;71(1):71-8
18164829
Int J Radiat Oncol Biol Phys. 2001 Nov 1;51(3):711-7
11597813
Int J Radiat Oncol Biol Phys. 1995 Sep 30;33(2):339-48
7673021
Int J Radiat Oncol Biol Phys. 2007 Nov 1;69(3):839-45
17544592
Int J Radiat Oncol Biol Phys. 2007 Oct 1;69(2):589-97
17869672
J Clin Oncol. 2003 Jul 1;21(13):2529-36
12829672
Int J Radiat Oncol Biol Phys. 2008 May 1;71(1):79-86
18164847
J Neurooncol. 1989 Sep;7(3):241-7
2677257
J Clin Oncol. 2003 Oct 1;21(19):3557-8
12913103
Int J Radiat Oncol Biol Phys. 1994 Jul 1;29(4):711-7
8040016
Stroke. 2005 Jul;36(7):1415-20
15947272
Radiother Oncol. 1993 Feb;26(2):111-6
7681997
JAMA. 1998 Nov 4;280(17):1485-9
9809728
Neurosurgery. 1989 Jun;24(6):798-805
2473409
J Neurooncol. 1996 Mar;27(3):269-77
8847561
Int J Radiat Oncol Biol Phys. 2007 Jan 1;67(1):240-3
17056192
Ann Neurol. 1993 Jun;33(6):583-90
8498838
J Neurol Sci. 2007 Jun 15;257(1-2):67-71
17316691
Cancer Res. 1992 Aug 15;52(16):4548-9
1322794
Cancer. 2004 Jan 15;100(2):398-404
14716777