A Pilot Study of Functional MRI to Evaluate Neurocognition After Brain Radiation

SUMMARY

You have been asked to participate in this research study because you have brain metastases(spread of cancer to the brain) which will be treated with Whole Brain Radiotherapy (WBRT).  The purpose of this study is to evaluate any changes seen in fMRI (functional magnetic resonance imaging) taken before and 3 months after WBRT.  The additional research imaging studies will be done as part of the same appointment for your standard MRI scan of the brain. The imaging studies will be performed along with a detailed cognition analysis.  This pilot study will investigate if early changes seen on fMRI imaging can be helpful in predicting long term effects of the radiation therapy.  Your participation on this study is expected to last 3 months. 

In patients with cancer that has spread to the brain, WBRT remains the most common and most effective therapy to manage the disease.  Multiple studies have shown that WBRT can cause shrinkage or stabilization of disease within the brain.  This can prolong patients’ lives and prevent cancer induced decline in neurologic function.  However, one of the potential side effects of WBRT in some patients is a radiation induced decline in neurologic function.  The exact mechanism of these declines and the specific locations within the brain affected by radiation remains incompletely understood.

 

MRI (magnetic resonance imaging) is a tool that is widely used for cancer imaging.  It is a technique that uses magnets, radiowaves and a computer to create a picture of the internal body.  It has been used in the diagnosis of your brain metastasis and is routinely part of the standard of care for monitoring disease within the brain.  MRI scans of the brain are a standard way to assess metastases in the brain before WBRT.

 

FMRI is a specific type of MRI that allows physicians to see areas of the brain engaged during mental tasks.  When parts of the brain are activated, blood travels to those areas to provide glucose for energy.  The fMRI allows us to see active changes in blood flow as a result of specific mental activities. 

           

            FMRI does not require any substance injected into the veins (contrast).  It does not feel any different than any other MRI.  FMRI takes around sixty minutes longer than a regular scan.  In order to visualize specific neurologic activation, patients view a computer screen with a series of numbers and are asked to press a button whenever they see a certain number repeated (N-back stimulation). This technique has revolutionized cognitive neuroscience as it has provided scientists additional insights into complex neurologic function.

 

The purpose of this study is to examine if changes in memory and concentration can be seen with the fMRI scan.  In order to evaluate these functions, you will need to be examined by a trained neuropsychologist.  You will be asked a series of questions (neurocognitive tests) over approximately 60 minutes to evaluate your memory and thinking.  These questions will be asked before your WBRT (baseline) and a few months afterwards to evaluate any changes.

 

At the same time as you have these questions, we will use the fMRI scanner to see the areas in your brain that are being used during mental tasks.  The goal of the study is to see if any changes on these questions will go along with changes on the fMRI scan. 

COH Protocol Number : 13398

Principal Investigator : Wong, Jeffrey M.D.

Sponsor : City of Hope

BRIEF ELIGIBILITY CRITERIA :

Eligible Ages : >=18

Gender : Either

Prior Chemotherapy :

Brain Metastases :

Measurable Disease :