Dr. Gondi’s Hippocampal Avoidance Study Among Top-Five Downloads of 2020
March 25, 2021 | 2 min. to read
Ground-breaking research co-led by board-certified radiation oncologist Vinai Gondi, MD, Northwestern Medicine Proton Center, was one of the top-five articles published in the Journal of Clinical Oncology in 2020, based on downloads and social media activity.
The phase III clinical trial showed that hippocampal avoidance (HA) using intensity-modulated radiotherapy during whole-brain radiotherapy (WBRT) plus memantine for brain metastases better preserves cognitive function and patient-reported symptoms, with no difference in survival. As a result of this research, study leads suggest a new standard of care for patients with brain metastases and good performance status who plan to receive WBRT and have no metastases in the hippocampus.
“With these findings, HA-WBRT plus memantine should be considered a standard of care for patients planning to receive WBRT,” says Dr. Gondi. Paul D. Brown, MD, radiation oncologist in the Department of Radiation Oncology at Mayo Clinic and the study’s co-lead author, says, “To our knowledge, this trial provides the first definitive clinical evidence that the hippocampal neuro-regenerative niche is important to the pathophysiology of radiotherapy-induced cognitive decline and builds on extensive preclinical work and prior clinical studies.”
Between July 2015 and March 2018, 518 patients with brain metastases were randomly assigned to the study. Median follow-up for patients was 7.9 months. Risk of cognitive failure was significantly lower after HA-WBRT plus memantine, compared with WBRT plus memantine (adjusted hazard ratio, 0.74; 95% CI, 0.58-0.95; P = .02). This difference was attributable to less deterioration in executive function at 4 months (23.3% versus 40.4%, P = .01) and learning and memory at 6 months (11.5% versus 24.7%, P = .049, and 16.4% versus 33.3%, P = .02, respectively).
Treatment groups did not differ significantly in overall survival, intracranial progression-free survival, or toxicity. At 6 months, using all data, patients who received HA-WBRT plus memantine reported less fatigue (P = .04), less difficulty with remembering things (P = .01), and less difficulty with speaking (P = .049). Using imputed data, reports indicated that patients who received HA-WBRT had less interference of neurologic symptoms in daily activities (P = .008) and fewer cognitive symptoms (P = .01).
Dr. Gondi received his medical degree from Columbia University Vagelos College of Physicians and Surgeons. He completed an internship at Icahn School of Medicine at Mount Sinai St. Luke’s Roosevelt Hospital Center, and a residency at University of Wisconsin Hospitals and Clinics. Dr. Gondi serves on the medical staffs of Central DuPage Hospital, Delnor Hospital, Kishwaukee Hospital and the Northwestern Medicine Proton Center.