title: Preservation of neurocognitive function and local control of 1 to 3 brain metastases treated with surgery and carmustine wafers.
abstract: BACKGROUND
  Neurosurgical resection and whole-brain radiation therapy (WBRT) are accepted treatments for single and oligometastatic cancer to the brain. To avoid the decline in neurocognitive function (NCF) linked to WBRT, the authors conducted a prospective, multicenter, phase 2 study to determine whether surgery and carmustine wafers (CW), while deferring WBRT, could preserve NCF and achieve local control (LC).
  
  
  METHODS
  NCF and LC were measured in 59 patients who underwent resection and received CW for a single (83%) or dominant (oligometastatic, 2 to 3 lesions) metastasis and received stereotactic radiosurgery (SRS) for tiny nodules not treated with resection plus CW. Preservation of NCF was defined as an improvement or a decline ≤ 1 standard deviation from baseline in 3 domains: memory, executive function, and fine motor skills, evaluated at 2-month intervals.
  
  
  RESULTS
  Significant improvements in executive function and memory occurred throughout the 1-year follow-up. Preservation or improvement of NCF occurred in all 3 domains for the majority of patients at each of the 2-month intervals. NCF declined in only 1 patient. The chemowafers were well tolerated, and serious adverse events were reversible. There was local recurrence in 28% of the patients at 1-year follow-up.
  
  
  CONCLUSIONS
  Patients with brain metastases had improvements in their cognitive trajectory, especially memory and executive function, after treatment with resection plus CW. The rate of LC (78%) was comparable to historic rates of surgery with WBRT and superior to reports of WBRT alone. For patients who undergo resection for symptomatic or large-volume metastasis or for tissue diagnosis, the addition of CW can be considered as an option.
authors.affiliation: Department of Neuro-Oncology, Moffitt Cancer Center, Tampa, Florida; Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania and the Abramson Cancer Center, Philadelphia, Pennsylvania.
authors.forename: Steven
authors.initials: S
authors.lastname: Brem
authors.forename: Christina A
authors.initials: CA
authors.lastname: Meyers
authors.forename: Gary
authors.initials: G
authors.lastname: Palmer
authors.forename: Margaret
authors.initials: M
authors.lastname: Booth-Jones
authors.forename: Surbhi
authors.initials: S
authors.lastname: Jain
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Ewend
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000008:administration & dosage; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery*; D002330:Carmustine / Q000008:administration & dosage*; D003071:Cognition / Q000187:drug effects* / Q000502:physiology; D003072:Cognition Disorders / Q000453:epidemiology / Q000517:prevention & control; D003131:Combined Modality Therapy; D004343:Drug Implants; D005260:Female; D006801:Humans; D036502:Infusions, Intralesional; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D019635:Neurosurgical Procedures
chemical_list: D018906:Antineoplastic Agents, Alkylating; D004343:Drug Implants; D002330:Carmustine
keywords: brain metastases; carmustine wafers; neurocognitive function; stereotactic radiosurgery; whole brain radiotherapy
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