Memantine for the prevention of cognitive dysfunction in patients receiving whole-brain radiotherapy: a randomized, double-blind, placebo-controlled trial

作者：Paul David Brown, Shannon K. Pugh, Nadia N. Laack, Jeffrey Scott Wefel, Deepak Khuntia, Christina Meyers, Ali K. Choucair, Sherry Fox, John H. Suh, David Roberge, Vivek S. Kavadi, Søren Møller Bentzen, Minesh P. Mehta, Deborah Watkins Bruner, for the Radiation Therapy Oncology Group (RTOG) · 发表于：Neuro-Oncology · 年份：2013 · DOI：10.1093/neuonc/not114 · 被引用次数：965 · 研究领域：Cancer-related cognitive impairment studies、Brain Metastases and Treatment、Intensive Care Unit Cognitive Disorders

BACKGROUND: To determine the protective effects of memantine on cognitive function in patients receiving whole-brain radiotherapy (WBRT). METHODS: Adult patients with brain metastases received WBRT and were randomized to receive placebo or memantine (20 mg/d), within 3 days of initiating radiotherapy for 24 weeks. Serial standardized tests of cognitive function were performed. RESULTS: Of 554 patients who were accrued, 508 were eligible. Grade 3 or 4 toxicities and study compliance were similar in the 2 arms. There was less decline in delayed recall in the memantine arm at 24 weeks (P = .059), but the difference was not statistically significant, possibly because there were only 149 analyzable patients at 24 weeks, resulting in only 35% statistical power. The memantine arm had significantly longer time to cognitive decline (hazard ratio 0.78, 95% confidence interval 0.62-0.99, P = .01); the probability of cognitive function failure at 24 weeks was 53.8% in the memantine arm and 64.9% in the placebo arm. Superior results were seen in the memantine arm for executive function at 8 (P = .008) and 16 weeks (P = .0041) and for processing speed (P = .0137) and delayed recognition (P = .0149) at 24 weeks. CONCLUSIONS: Memantine was well tolerated and had a toxicity profile very similar to placebo. Although there was less decline in the primary endpoint of delayed recall at 24 weeks, this lacked statistical significance possibly due to significant patient loss. Overall, patients treat...