
==== Front
Neurooncol Adv
Neurooncol Adv
noa
Neuro-Oncology Advances
2632-2498
Oxford University Press US

10.1093/noajnl/vdae090.094
vdae090.094
Final Category: Ongoing Clinical Trials
AcademicSubjects/MED00300
AcademicSubjects/MED00310
OCTS-09 THE PROSPECTIVE PHASE II COG-SRS TRIAL: AN UPDATE ON COGNITIVE-SPARING STEREOTACTIC RADIOSURGERY FOR BRAIN METASTASES
Puett Connor University of California San Diego, San Diego, CA, USA

Hopper Austin University of California San Diego, San Diego, CA, USA

Connor Michael University of California San Diego, San Diego, CA, USA

Karunamuni Roshan University of California San Diego, San Diego, CA, USA

Sanghvi Parag University of California San Diego, San Diego, CA, USA

Kim Grace University of California San Diego, San Diego, CA, USA

Bruggeman Andrew University of California San Diego, San Diego, CA, USA

Tringale Kathryn University of California San Diego, San Diego, CA, USA

Moiseenko Vitali University of California San Diego, San Diego, CA, USA

Farid Nikdokht University of California San Diego, San Diego, CA, USA

McDonald Carrie University of California San Diego, San Diego, CA, USA

Hattangadi-Gluth Jona University of California San Diego, San Diego, CA, USA

8 2024
02 8 2024
02 8 2024
6 Suppl 1 2024 SNO/ASCO CNS Metastases Conference i28i28
© The Author(s) 2024. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology.
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

Abstract

Stereotactic radiosurgery (SRS) plans that respect the neural correlates of cognition should result in better post-treatment cognitive outcomes compared to standard plans. The prospective phase II COG-SRS Trial is designed to test this hypothesis. To date, 92 treatment plans that ensure standard tumor coverage but also constrain doses to selected eloquent white matter tracts and the hippocampi have been developed for 70 patients with a total of 158 brain metastases arising from various cancer types. The most common primary malignancies were lung (40%) and breast (26%). Over 90% of plans treated 3 or fewer lesions. 80% of plans successfully met the 0.03cc dose (D0.03) constraint to all white matter tracts, and 95% met the D0.03 constraint to the hippocampi. Cognitive testing of immediate and delayed recall (Hopkins Verbal Learning Test-Revised) and letter and category fluency (Controlled Oral Word Association) is available in 66% (46/70) of patients to date, 76% (35/46) of whom had received systemic therapy and 20% (9/46) surgical resection prior to SRS. Comparing pre- and 3-month post-radiotherapy performance, 52% (24/46) had a significant decline in cognitive performance, defined as a decrease of at least 1 standard deviation in the score on one or more tests. In patients for whom the D0.03 constraint could not be met in white matter tracts, 70% declined significantly. In comparison, only 47% declined when the D0.03 constraint was met. Correlating associations between specific white matter tract doses, volumetric white matter tract changes assessed by serial MRI, and performance on the full battery of neuropsychological testing will be possible when trial data are finalized. These results should help in defining the radiosensitivity of distinct neuroanatomic regions and in guiding future dose-constraint planning protocols, as this new arena of cognitive-sparing SRS continues to be explored.
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pmc
