Avoiding the Hippocampus During Whole-Brain Radiation Therapy in Treating Patients With Brain Metastases

INCLUSION CRITERIA:

   - Histologically or cytologically confirmed non-hematopoietic malignancy within the past
   5 years

      - If histologic proof of malignancy is from > 5 years ago, then a more recent
      pathological confirmation is required (e.g., from systemic metastatic or brain
      metastasis)

      - Patients with metastasis of unknown primary tumor are permitted

   - Measurable brain metastasis outside a 5-mm margin around either hippocampus on
   gadolinium contrast-enhanced MRI obtained within the past 30 days

   - Have not been or will not be treated with stereotactic radiosurgery (SRS) or surgical
   resection

      - These treatment options are allowed only at relapse

   - Patients who have brain metastases at initial presentation allowed and do not need to
   demonstrate 3 months of stable scans

   - At least 1 week since open biopsy

   - Karnofsky performance status 70-100%

   - Fertile patients must use effective contraception

   - Negative pregnancy test 2 weeks or less prior to study entry

   - Patients must be English proficient, with patients who speak English as a second
   language eligible

EXCLUSION CRITERIA:

   - Small cell lung cancer or germ cell malignancy

   - Leptomeningeal metastases

   - Non-small cell lung cancer-associated brain metastases with ≥ 2 organ sites of
   extracranial metastases

   - Radiologic evidence of hydrocephalus

   - Serum creatinine > 1.4 mg/dL within 30 days prior to study entry

   - Pregnant or nursing

   - Contraindication to MRI imaging such as implanted metal devices or foreign bodies or
   severe claustrophobia

   - Severe, active co-morbidity including any of the following:

      - Unstable angina and/or congestive heart failure requiring hospitalization within
      the past 6 months

      - Transmural myocardial infarction within the past 6 months

      - Acute bacterial or fungal infection requiring intravenous antibiotics

      - Hepatic insufficiency resulting in clinical jaundice and/or coagulation defects

      - Chronic obstructive pulmonary disease exacerbation or other respiratory illness
      requiring hospitalization or precluding study therapy

      - Uncontrolled, clinically significant cardiac arrhythmias

   - Prior radiotherapy to the brain

   - Plan for chemotherapy or targeted therapies during WBRT or during the subsequent 7
   days