Memantine in the Prevention of Radiation-Induced Brain Damage: A Narrative Review
Preserving cognitive functions is a priority for most patients with brain metastases. Knowing the mechanisms of hyperglutamatergic neurotoxicity and the role of some hippocampal areas in cognitive decline (CD) led to testing both the antiglutamatergic pharmacological prophylaxis and hippocampal-spar...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-05-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/14/11/2736 |
| _version_ | 1797493910531997696 |
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| author | Claudia Scampoli Silvia Cammelli Erika Galietta Giambattista Siepe Milly Buwenge Gabriella Macchia Francesco Deodato Savino Cilla Lidia Strigari Silvia Chiesa Alessio Giuseppe Morganti |
| author_facet | Claudia Scampoli Silvia Cammelli Erika Galietta Giambattista Siepe Milly Buwenge Gabriella Macchia Francesco Deodato Savino Cilla Lidia Strigari Silvia Chiesa Alessio Giuseppe Morganti |
| author_sort | Claudia Scampoli |
| collection | DOAJ |
| description | Preserving cognitive functions is a priority for most patients with brain metastases. Knowing the mechanisms of hyperglutamatergic neurotoxicity and the role of some hippocampal areas in cognitive decline (CD) led to testing both the antiglutamatergic pharmacological prophylaxis and hippocampal-sparing whole-brain radiotherapy (WBRT) techniques. These studies showed a relative reduction in CD four to six months after WBRT. However, the failure to achieve statistical significance in one study that tested memantine alone (RTOG 0614) led to widespread skepticism about this drug in the WBRT setting. Moreover, interest grew in the reasons for the strong patient dropout rates in the first few months after WBRT and for early CD onset. In fact, the latter can only partially be explained by subclinical tumor progression. An emerging interpretation of the (not only) cognitive impairment during and immediately after WBRT is the dysfunction of the limbic and hypothalamic system with its immune and hormonal consequences. This new understanding of WBRT-induced toxicity may represent the basis for further innovative trials. These studies should aim to: (i) evaluate in greater detail the cognitive effects and, more generally, the quality of life impairment during and immediately after WBRT; (ii) study the mechanisms producing these early effects; (iii) test in clinical studies, the modern and advanced WBRT techniques based on both hippocampal-sparing and hypothalamic-pituitary-sparing, currently evaluated only in planning studies; (iv) test new timings of antiglutamatergic drugs administration aimed at preventing not only late toxicity but also acute effects. |
| first_indexed | 2024-03-10T01:26:46Z |
| format | Article |
| id | doaj.art-63003baee0ab431fa6f5c95bb010b153 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T01:26:46Z |
| publishDate | 2022-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-63003baee0ab431fa6f5c95bb010b1532023-11-23T13:50:17ZengMDPI AGCancers2072-66942022-05-011411273610.3390/cancers14112736Memantine in the Prevention of Radiation-Induced Brain Damage: A Narrative ReviewClaudia Scampoli0Silvia Cammelli1Erika Galietta2Giambattista Siepe3Milly Buwenge4Gabriella Macchia5Francesco Deodato6Savino Cilla7Lidia Strigari8Silvia Chiesa9Alessio Giuseppe Morganti10Department of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, 40138 Bologna, ItalyDepartment of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, 40138 Bologna, ItalyDepartment of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, 40138 Bologna, ItalyRadiation Oncology, IRCCS Azienda Ospedaliero, Universitaria di Bologna, 40138 Bologna, ItalyDepartment of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, 40138 Bologna, ItalyRadiation Oncology, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, 86100 Campobasso, ItalyRadiation Oncology, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, 86100 Campobasso, ItalyMedical Physics, Gemelli Molise Hospital, Università Cattolica del Sacro Cuore, 86100 Campobasso, ItalyMedical Physics, IRCCS Azienda Ospedaliero, Universitaria di Bologna, 40138 Bologna, ItalyUOC di Radioterapia Oncologica, Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, ItalyDepartment of Experimental, Diagnostic and Specialty Medicine-DIMES, Alma Mater Studiorum University of Bologna, 40138 Bologna, ItalyPreserving cognitive functions is a priority for most patients with brain metastases. Knowing the mechanisms of hyperglutamatergic neurotoxicity and the role of some hippocampal areas in cognitive decline (CD) led to testing both the antiglutamatergic pharmacological prophylaxis and hippocampal-sparing whole-brain radiotherapy (WBRT) techniques. These studies showed a relative reduction in CD four to six months after WBRT. However, the failure to achieve statistical significance in one study that tested memantine alone (RTOG 0614) led to widespread skepticism about this drug in the WBRT setting. Moreover, interest grew in the reasons for the strong patient dropout rates in the first few months after WBRT and for early CD onset. In fact, the latter can only partially be explained by subclinical tumor progression. An emerging interpretation of the (not only) cognitive impairment during and immediately after WBRT is the dysfunction of the limbic and hypothalamic system with its immune and hormonal consequences. This new understanding of WBRT-induced toxicity may represent the basis for further innovative trials. These studies should aim to: (i) evaluate in greater detail the cognitive effects and, more generally, the quality of life impairment during and immediately after WBRT; (ii) study the mechanisms producing these early effects; (iii) test in clinical studies, the modern and advanced WBRT techniques based on both hippocampal-sparing and hypothalamic-pituitary-sparing, currently evaluated only in planning studies; (iv) test new timings of antiglutamatergic drugs administration aimed at preventing not only late toxicity but also acute effects.https://www.mdpi.com/2072-6694/14/11/2736literature reviewradiotherapyprophylaxismemantinebrain damage |
| spellingShingle | Claudia Scampoli Silvia Cammelli Erika Galietta Giambattista Siepe Milly Buwenge Gabriella Macchia Francesco Deodato Savino Cilla Lidia Strigari Silvia Chiesa Alessio Giuseppe Morganti Memantine in the Prevention of Radiation-Induced Brain Damage: A Narrative Review Cancers literature review radiotherapy prophylaxis memantine brain damage |
| title | Memantine in the Prevention of Radiation-Induced Brain Damage: A Narrative Review |
| title_full | Memantine in the Prevention of Radiation-Induced Brain Damage: A Narrative Review |
| title_fullStr | Memantine in the Prevention of Radiation-Induced Brain Damage: A Narrative Review |
| title_full_unstemmed | Memantine in the Prevention of Radiation-Induced Brain Damage: A Narrative Review |
| title_short | Memantine in the Prevention of Radiation-Induced Brain Damage: A Narrative Review |
| title_sort | memantine in the prevention of radiation induced brain damage a narrative review |
| topic | literature review radiotherapy prophylaxis memantine brain damage |
| url | https://www.mdpi.com/2072-6694/14/11/2736 |
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