Neoplasms

Symptoms and General Pathology

All Conditions

Neoplasm Metastasis

Neoplastic Processes

patients in the observation arm receive no adjuvant local radiation therapy after complete surgical resection of a cerebral metastasis

patients in the intervention arm receive an adjuvant local radiation therapy (cavity boost radiation therapy: 10 x 3 Gy ad 30 Gy; clinical target volume (CTV): resection cavity plus surrounding 5 mm; planning target volume (PTV): CTV + 1mm)

Cavity boost radiation therapy with 10 x 3 Gy for patients suffering from complete resected cerebral metastases

Cavity boost radiation

Marcel A. Kamp, MD

Michael Sabel, Prof. Dr.

Wilfried Budach, Prof. Dr.

The purpose of this study is to determine whether a local fractionated radiation therapy achieves a better local tumor control after complete surgical metastases resection at 6 month as compared to observation alone. Further it should be evaluated if cognitive functioning and quality of life is similar in both groups.

The surgical resection of cerebral metastases as a key element in a multimodal therapeutic concept of brain metastatic patients is included in the common recommendations and international guidelines (level I evidence). These recommendations are based on a series of prospective, randomized and controlled studies which addressed the impact of the surgical metastases resection combined with a whole-brain radiation therapy (WBRT) in comparison to WBRT alone. Achieving local tumor control is the major goal of surgery and local tumor control rate after surgery alone has been addressed in few studies: A prospective, randomized American multicenter study revealed a local recurrence rate of 46% by median follow-up of 43 weeks for patients who underwent surgery alone without an adjuvant radiation therapy. Similarly, the 2-year local recurrence rate after metastases resection alone was 53.1% in a retrospective Korean study and 59% in the prospective, randomized and controlled EORTC 22952-26001 study.

In conclusion, standard surgery alone is not sufficient to achieve local control in about 50% of patients (evidence level I). Therefore, surgery of cerebral metastases is often followed by an adjuvant radiation therapy, which is an important part of a multi-modal therapy. Evidence for an additional adjuvant whole-brain radiation therapy (WBRT) after surgical resection was gained from a first prospective, randomized study in 1998: Patients treated by surgery followed by adjuvant WBRT had a significant lower local in-brain progression rate as compared to patients randomized to surgery alone (46% with a median follow-up of 48 weeks in the observation group vs. 10% with a median follow-up of 43 weeks). This result was recently confirmed by the EORTC 22952-26001 study: The 2-year local in-brain progression rate after surgical resection was reduced by a WBRT from 59% to 27%. But despite the lower local and also lower distant in-brain progression rate, the WBRT had no significant influence on the overall survival. The additional analysis of the quality of life data of the EORTC 22952-26001 study showed, that a WBRT negatively impacts the health-related quality of life with a statistically relevant and clinically significant impairment of the physical functioning (at 8 weeks), cognitive functioning and of the global health status. In conclusion, WBRT after surgery of cerebral metastases significantly reduces the incidence of local recurrences but has no impact on the overall survival and has a significant negative impact on the patient´s quality of life and cognitive function. Therefore, WBRT is not mandatory as adjuvant concept after surgical metastases resection and does not have an additional oncological impact in comparison to observation.

A local fractionated radiation therapy in analogy to the WBRT might achieve a similar local tumor control than observation alone but might be associated with an improved cognitive functioning as compared to WBRT. The purpose of this study is to determine whether a local fractionated radiation therapy achieves a better local tumor control after complete surgical metastases resection at 6 month as compared to observation alone. Further it should be evaluated if cognitive functioning and quality of life is similar in both groups.

Cavity Boost Radiation Therapy vs. Observation in Cerebral Metastases After Complete Surgical Resection

Primary outcome measure is the local tumor control of resected metastases after local cavity boost radiation therapy or observation at 6 month

Secondary outcome measure is the local tumor control of resected metastases after local cavity boost radiation therapy or observation at 12 and 18 month

Secondary outcome measure is the distant tumor control at 6, 12 and 18 month

Secondary outcome measure is the incidence of a leptomeningeal carcinosis at 6, 12 and 18 month

Secondary outcome measure is the patients quality of life at 3, 6, 9 12, 15, 18 month as assessed by the Eortc qlq bn20 questionaire

Secondary outcome measure is the patients quality of life at 3, 6, 9, 12, 15 and 18 month as assessed by the Eortc qlq c30 questionaire

Secondary outcome measure is the patients neurocognitive functioning at 3, 6, 9 12, 15 and 18 month as assessed by the MMSE

Secondary outcome measure is the patients neurocognitive functioning at 3, 6, 9, 12, 15 and 18 month as assessed by the Hopkins Verbal Learning Test (HVLT),

Secondary outcome measure is the patients neurocognitive functioning at 3, 6, 9 12, 15 and 18 month as assessed by the Controlled Oral Word Association (COWA)

Secondary outcome measure is the patients neurocognitive functioning at 3, 6, 9 12, 15 and 18 month as assessed by the Test and Trail-Making Test (TMT) A \& B

Heinrich-Heine University, Duesseldorf

Rare Diseases

Glioma

contribution of PET 18FDOPAimagery in high level glioma diagnosis

PET 18FDOPA

Jacques DARCOURT, phd

In standard care for patients diagnosed with a primary or secondary (metastasis) cerebral tumor, there is currently complex clinical situations in which the clinic and Magnetic Resonance Imagery (MRI) do not allow for the medical team to arrive at a conclusive diagnosis. The therapeutic proposition requires then a delay in additional follow-up of at least 3 months in order to clarify the situation, with a potential delay in diagnosis and therefore therapeutic care. The contribution of cerebral molecular imagery could allow for new additional information to be brought in or to increase the confidence index in the diagnosis in order to comfort the therapeutic collective attitude proposed in the multidisciplinary meeting (MM).

3.4-dihydroxy-6-18F-fluoro-L-phenylalanine (18F-FD0PA), dopamine precursor amino-acid, Position Emission Tomography (PET), allows for the studying in vivo of the proteic transmembrane transport in gliomatous tissue; active transport happens through a sodic-independent canal, increased in malicious transformations, and in which kinetics can give an indication regarding the development of the primary tumor.

In MRIs, tumor tissue growth after injecting the contrast product translates to a rupture in the Blood-Brain Barrier (BBB), while tumor extraction from the radiopharmaceutical is independent of the state of integrity of the BBB and whose only function is metabolic tissue activity. This method of imagery thus appears as a promising contribution to conventional imagery.

Furthermore, different to 18F-FDG (18F-2-fluoro-2-deoxy-D-glucose fluorodeoxyglucose), similar to the largely used glucose in oncologic molecular imagery, exploration of harmful glioma in 18F-FDOPA, is not compromised by background noise activity, and is almost useless in a healthy cerebral cortex, with the exception of striatal physiological fixation used as a level of reference. The best performances in terms of positive and negative predictive value were defined in the literature with a tumor/striatum threshold of 1.

According to the latest and current European recommendations, turning to PET when caring for high-level gliomas patients can be proposed in the evaluation of therapeutic responses. However, very few studies have evaluated the in-practice current clinical contributions of PET and put it into perspective with classic clinical radiological data.

The primary hypothesis rests on the fact that 18F-FDOPA PET imagery can modify decisions regarding the treatment of patients during oncologic neurological MDM. It's a matter of measuring the frequency in attitude and situations changes in which these changes most often occur.

Secondly, the study will have the objective, during patient follow-up, to evaluate the pertinence of these changes in decisions, as well as the usage of PET in relation to clinical situations:

* The differential diagnosis between radionecrosis or pseudo-progression and recurrence before newly appeared contrast zones in patients diagnosed a high glioma level or metastasis and treated by radiotherapy; either with or without chemotherapy.
* The evaluation at the end of treatment with introductory level temozolomide (TMZ) (6th cycle) after adjuvant radio-chemotherapy of a high-level primary cerebral tumor.
* The evaluation of the response under anti-angeogenic treatment

The expected benefit of this study is an improvement in the patient's care. Indeed, the additional information provided by Position Emission Tomography (PET) could allow for healthcare professionals to more precociously test for recurrence and thus diminish the delay in therapeutic care. Conversely, the PET could allow for healthcare professionals to avoid over-treatment of patients for whom the MRI would wrongly indicate a recurrence. Furthermore, imagery by PET should bring a new level of additional information allowing for an increase in the confidence index when being diagnosed, thus comforting the collective therapeutic attitude proposed in the MM.

Prospective Study on Oncologic Cerebral Imagery Contribution by 18F-FDOPA Position Emission Tomography (PET)

Prospective Study on Oncologic Cerebral Imagery Contribution by 18F-FDOPA Position Emission Tomography (PET) in a Multidisciplinary Meeting Therapeutic Proposal When Caring for Patients Diagnosed Primary or Secondary Cerebral Tumors

Centre Antoine Lacassagne

fluorescence guided microsurgical resection (under 560 nm filter) in addition to the usual techniques, after iv injection of 200 mg (i.e. 3-4 mg/kg) of fluorescein sodium at the time of skin incision.

microsurgical resection with usual techniques

resection of cerebral metastases by microsurgery

microsurgical resection

Jean Francois OUDET

Marie Barba

Few studies have evaluated the use of fluorescein sodium for the resection of brain tumours (especially glioblastomas) but also cerebral metastases. We therefore propose to evaluate the technique of fluorescence guided microsurgery (fluorescein sodium) compared to the conventional microsurgical technique in the resection of cerebral metastases in adults in order to specify, by a prospective and randomised study, the assistance provided by this technique in the quality of resection and the gain in terms of overall survival and local control of brain disease.

Cerebral metastases are a major public health problem in cancer patients. They are the most common brain tumours in adults. It is estimated that approximately 20-40% of patients with primary malignant neoplasia will develop cerebral metastasis during the course of their illness. In addition, the incidence of brain metastases is increasing due, in particular, to the aging of the population, as well as to the improvement of the overall management of cancer patients (cytotoxic or targeted systemic treatment) and easier access to magnetic resonance imaging (MRI), which improves patient survival. The prognosis of patients with brain metastases is still poor and the median overall survival of these patients is of the order of a few months. Although the management of brain metastases is multidisciplinary, the benefit of surgery has been clearly demonstrated in the literature. Consequently, it is demonstrated that the quality of the tumour excision and in particular the carrying out of the complete excision of contrast enhancement on the MRI is correlated with improved overall survival (especially in case of single metastasis) and improved local control of the disease or progression-free survival, but also a better quality of life. It is therefore essential to perform the most complete excision possible while minimising the associated morbidity. For this purpose, various tools for surgical resection have been developed and are available, including intraoperative fluorescence guided surgery. Sodium fluorescein is a fluorochrome that accumulates, after intravenous injection, into vascularised tumour tissues and is revealed intraoperatively by a light source of suitable wavelength (560 nm) using a set of lenses included in the microscope. The resection is thus guided by this fluorescence, the complete disappearance of which will translate into a complete tumour resection. Its interest is twofold: to increase the percentage of complete tumour resection and to improve survival without recurrence and overall survival.Few studies have evaluated the use of fluorescein sodium for the resection of brain tumours (especially glioblastomas) but also cerebral metastases. If two studies on brain metastases showed a complete resection rate greater than 80% and a better rate of local control of brain disease, it is important to note that these studies were not randomised (with a control arm), they did not really prove the effectiveness of this technique under fluorescence, hence the need to set up a randomised study. We therefore propose to evaluate the technique of fluorescence guided microsurgery (fluorescein sodium) compared to the conventional microsurgical technique in the resection of cerebral metastases in adults in order to specify, by a prospective and randomised study, the assistance provided by this technique in the quality of resection and the gain in terms of overall survival and local control of brain disease.

Evaluation of Resection Quality of Cerebral Metastases Using Fluorescence Guided Surgery: a Prospective Randomised Study

Evaluation of Resection Quality of Cerebral Metastases Using Fluorescence Guided Surgery: a Prospective Randomised Study- Fluomet Study

To evaluate the quality of excision in both neurosurgical techniques, in terms of complete resection of cerebral metastases, objectified by the absence of quantifiable tumour residues on early postoperative MRI (before 48 hours) in both groups, evaluated by one of the neuroradiologists associated with the project.

Dr Philippe METELLUS

Ramsay Générale de Santé

Nervous System Diseases

Brain Neoplasms

Central Nervous System Neoplasms

Nervous System Neoplasms

Brain Diseases

Central Nervous System Diseases

standard WBRT to a total dose of 30 Gy in 10 fractions

The experimental group will be treated with helical tomotherapy giving 3 Gy per fraction to the whole brain up to a total dose of 30 Gy in 10 fractions and raising the prescribed dose to the brain metastases to 5 Gy per fraction. The dose fall off to the normal brain should be as steep as possible around each brain metastasis. The optic chiasm and the optic nerves should not receive more than 3.5 Gy per fraction.

WBRT in 10 fractions to a total dose of 30Gy

whole brain radiotherapy

Total dose: 10 fractions: whole brain total dose: 30Gy, metastases: total dose 50Gy

whole brain radiotherapy with simultaneous boost

Andrea Wittig, MD

Martin Stuschke, MD pHD

Martin stuschke, MDpHD

Volker Budach, MD pHD

Simone Marnitz, MD pHD

Rudolf Schwarz, MD pHD

Rudolf Schwarz, MDpHD

Jürgen Debus, MD pHD

Klaus Herfarth, MDpHD

Klaus Herfarth, MD pHD

Michael Molls, MD pHD

Hans Geinitz, MD pHD

Hans Geinitz, Md pHD

Brain metastases occur in 20-40% of patients with primary extracerebral tumors. Despite important advances in therapy of malignant solid tumors and treatment of 1-3 brain metastases, multiple brain metastases continue to present a significant problem in attempting to prevent progression of disease and limit morbidity associated with therapy. The majority of patients who develop brain metastases have a short survival, effective palliation being transient. The median survival after diagnosis is as low as 3-6 months. However, there is some evidence that selected patients survive prolonged periods with vigorous therapeutic approach.

Specific therapeutic options are surgery, chemotherapy, conventional fractionated whole-brain radiotherapy (WBRT) and radiosurgery. Radiosurgery allows delivering of a single high dose fraction of radiation to targets of 3-3.5 cm maximum diameter. In patients with newly diagnosed brain metastases, a rapid decrease of symptoms, local tumor response rate of 73-90% and a median survival of 7-12 month have been reported.

WBRT alone is the treatment of choice for patients with multiple brain metastases, and for patients with single brain metastases not amenable to surgery or radiosurgery. Median survival after WBRT alone is 3-6 months.

WBRT and radiosurgery boost have been shown to improve survival in RPA class I patients and in patients with favorable histological status and squamous cell or non-small cell lung tumors. All randomized trials showed improved local control with the addition of radiosurgery to WBRT (Andrews, 2004).

WBRT in conjunction with radiosurgery improves local control and reduces the risk of new distant brain metastases, but most studies support that combined radiosurgery and WBRT does not improve the overall survival expect for patients without evidence of extracranial disease.

Helical Tomotherapy (HT) allows as a sole modality a new treatment option: Using HT, the advantage of applying a highly conformal boost dose to the metastases and WBRT can be combined in one treatment session. Therefore, it allows applying a high dose to multiple brain metastases in the sense of an integrated boost. The focus of this study is to investigate the efficacy and safety of WBRT with an integrated boost using this new treatment modality in comparison to the effects of conventional WBRT alone.

The principal objective of the trial is to assess the therapeutic efficacy of WBRT as compared to WBRT combined with integrated boost with HT delivered to patients with 2-10 brain metastases of solid tumors. The secondary objective is to evaluate the safety of WBRT as opposed to WBRT combined with integrated boost as delivered by HT in patients with 2-10 brain metastases.

Whole-Brain Radiotherapy (WBRT) Versus WBRT and Integrated Boost Using Helical Tomotherapy for Multiple Brain Metastases

Whole-Brain Radiotherapy (WBRT) vs. WBRT and Integrated Boost Using Helical Tomotherapy for Patients With Multiple Brain Metastases - a Multicentre Randomized Phase II Trial

University Hospital, Essen

Prof. Dr. med. Martin Stuschke

Jean Chenard, MD

Hypothesis: the pattern of MRI contrast enhancement after gadolinium injection is different in tumors that respond well to gamma knife.

We are going to acquire sequential T1-weighted images of brain lesions before, during and after injection of Gd-DTPA. This will be repeated before and after a treatment with gamma knife. We will then analyse our results to see if there are common enhancement characteristics between lesions that will respond well to the radiosurgery treatment. Response will be clinically assessed by tumor volume as determined by MRI approximately 4 to 6 months after treatment.

Predictive Value of Dynamic Contrast Enhancement MRI on a Cerebral Tumor Response to Gamma Knife Treatment

Prospective Study of Predictive Value of Dynamic Contrast Enhancement Magnetic Resonance Imaging With Gadolinium on the Response of a Cerebral Tumor to a Treatment With Gamma Knife

Tumor volume, Ktrans, ve, time at maximum signal enhancement, maximum signal difference, ADC, basal T1 value

Martin Lepage

Respiratory Tract (Lung and Bronchial) Diseases

Adenocarcinoma

Carcinoma, Non-Small-Cell Lung

Lung Neoplasms

Adenocarcinoma of Lung

Carcinoma

Respiratory Tract Neoplasms

Thoracic Neoplasms

Lung Diseases

Respiratory Tract Diseases

Carcinoma, Bronchogenic

Bronchial Neoplasms

Neoplasms, Glandular and Epithelial

Neoplasms by Histologic Type

Lung Adenocarcinoma

Antineoplastic Agents

All Drugs and Chemicals

Micronutrients

Hematinics

Vitamins

Bevacizumab

Pemetrexed

Cisplatin

Folic Acid

Vitamin B Complex

Vitamin B 12

Hydroxocobalamin

Antineoplastic Agents, Immunological

Angiogenesis Inhibitors

Growth Inhibitors

Enzyme Inhibitors

Folic Acid Antagonists

Folinic Acid

Methylcobalamin

Folate

Vitamin B9

Vitamin B12

Cobalamin

Cyanocobalamin

Arm A: Initial Cerebral Radiotherapy and Chemotherapy (Cisplatin and pemetrexed with or without Bevacizumab)

Arm B: Chemotherapy (Cisplatin and pemetrexed with or without Bevacizumab) and Cerebral Radiotherapy if clinical or radiological progression brain

Cisplatin 75 mg/m2 IV (with adequate hydration) on D1 every 3 weeks.

500mg/m² IV(10 min. infusion, preceded by the usual folic acid, vitamin B12 and corticosteroid premedication)on D1 every 3 weeks

7.5 mg/kg on D1 every 3 weeks. In case of eligibility for Bevacizumab, the latter will not be started until C2.

Cerebral radiotherapy (encephalon in toto, 30 gy 10 sessions and 12 days) immediately after randomization before D1.If the number of brain metastases is less than or equal to 5 and less than or equal to 5 cm size, cerebral stereotactic radiotherapy condition may be proposed. The recommended interval between randomisation and D1 will be approximately 4 weeks.

Cerebral Radiotherapy

Isabelle MONNET

The patients carrying a complicated primary lung cancer brain metastases die in less than 3 months of delay disease in the absence of treatment. The median survival of these patients is approximately six months when the treatment associated with radiotherapy chemotherapy based on cisplatin is now the standard treatment. In most studies the patients die of their brain disease in one case only two, so it is likely that some patients do not require brain irradiation (prognosis in this case is linked to extra-cerebral disease ). The benefits for patients in group B (without systematic irradiation) are not to suffer the side effects of this radiation. The risks are in the same group to see brain metastases become symptomatic.

The role of cerebral radiotherapy in the patients treated with chemotherapy is unclear: should all patients be irradiated systematically (since the "reference" treatment is involved and with the aim of obtaining better control of the brain lesions and maintaining a better neurological status) or should only the patients showing cerebral progression be irradiated (avoidance of possibly useless brain radiotherapy and its side effects). The aim of this study is to better determine the position of cerebral radiotherapy in this context.

Main objective:

determine whether there is a difference in terms of progression-free survival between a therapeutic strategy with initial systematic brain radiotherapy followed by chemotherapy cis-platine/alimta + / - Bevacizumab and strategy with an initial chemotherapy cis-platine/alimta + / - Bevacizumab associated with brain radiotherapy only in cases of cerebral progression in patients with NSCLC with asymptomatic brain metastases

This is a trial comparing two strategies with the aim to determine the best place for cerebral radiotherapy (initially or only systematic progression).

Arm A: Initial cerebral radiotherapy and chemotherapy, standard arm Arm B: Chemotherapy and Radiotherapy brain if clinical or radiological cerebral progression , experimental arm (The chemotherapy treatments are standard treatments using drugs with authorization in this indication)

Therapeutic Strategies in Patients With Non-squamous Non-small Cell Lung Cancer With Brain Metastases

Multicentric, Randomized, Phase III Trial Comparing 2 Strategies in Patients With Non-squamous Non-small Cell Lung Cancer With Asymptomatic Brain Metastases

Whether there is a difference in terms of progression-free survival between a therapeutic strategy with initial brain radiotherapy followed by systematic chemotherapy with cis-platinum / alimta and a strategy with initial chemotherapy with cis-platinum / alimta with brain radiotherapy only if brain progression in patients with non-small cell lung cancer with brain metastases asymptomatic.

After 4 cycles of chemotherapy with platinum salt-pemetrexed (with or without bevacizumab) possibly followed, in case of control of the disease and if the patient's condition allows, by pemetrexed (alone or with bevacizumab if the latter was part of the initial treatment) as maintenance treatment until progression.

Repeat examinations to assess the measurable lesions or initials and examination necessary to confirm the appearance of a new lesion in case of clinical suspicion of disease progression (minimum CT scan and MRI).The radiological treatment response will be measured according to the RECIST 1.1 criteria

The safety of the induction combination of cisplatin or carboplatin plus pemetrexed (Alimta®) +/- bevacizumab, the maintenance treatment with pemetrexed (Alimta®) +/- bevacizumab and the pancerebral radiotherapy will be assessed based on the CTC toxicity criteria v3.0.

The quality of life assessment measurement will be performed by self-questionnaire. The EURO-QOL questionnaire will be used.

The neurological assessment measurement will be performed by self-questionnaire. The MOCA questionnaires will be used.

Groupe Francais De Pneumo-Cancerologie

Centre Hospitalier Intercommunal Creteil

Physician

Undergo baseline testing of physical (lower body strength, endurance) and cognitive (executive functioning) abilities. 14 days (± 2 days) following WBRT/SRS: all arms undergo testing of physical (lower body strength, endurance) and cognitive (executive functioning) abilities. Arm 1: intervention of physical activity begins. 60 days (± 5 days) post testing after WBRT/SRS: all arms undergo final testing of physical (lower body strength, endurance) and cognitive (executive functioning) abilities.

Undergo baseline testing of physical (lower body strength, endurance) and cognitive (executive functioning) abilities. 14 days (± 2 days) following WBRT/SRS: all arms undergo testing of physical (lower body strength, endurance) and cognitive (executive functioning) abilities. Arm 2: intervention of both cognitive rehabilitation and physical activity begins. 60 days (± 5 days) post testing after WBRT/SRS: all arms undergo final testing of physical (lower body strength, endurance) and cognitive (executive functioning) abilities.

Undergo baseline testing of physical (lower body strength, endurance) and cognitive (executive functioning) abilities. Arm 3: Intervention of cognitive rehabilitation begins prior to and is concurrent with WBRT/SRS treatment. 14 days (± 2 days) following WBRT/SRS: all arms undergo testing of physical (lower body strength, endurance) and cognitive (executive functioning) abilities. Arm 3: continue intervention of cognitive rehabilitation; add intervention of physical activity. 60 days (± 5 days) post testing after WBRT/SRS: all arms undergo final testing of physical (lower body strength, endurance) and cognitive (executive functioning) abilities.

* Self-exercise: number of steps per day, per fitness tracker; self-report of daily activity.
* One-to-one intervention: 30 minute sessions with licensed therapist to include warm-up, generalized strengthening, stretching.

Physical Activity

One-to-one intervention: 45 minutes sessions with licensed therapist to include graded cognitive tasks designed to improve executive functioning with focus on both restorative and compensatory approaches.

Cognitive rehabilitation

Suzanne F. Taylor, PhD, MBA, OTR/L

To determine the feasibility of processes and instruments with an overarching purpose to guide the design of a larger study. To determine the feasibility of individuals with metastatic brain tumor(s) to engage in physical activity(PA) and cognitive rehabilitation (CR) as in an outpatient therapy setting.

Rolling recruitment for the study. Participants will be randomized into one of three treatment arms. All treatment arms will undergo physical \& cognitive testing prior to whole-brain radiation therapy (WBRT)/stereotactic radiosurgery (SRS). Arm 3 will receive cognitive rehabilitation intervention sessions prior to, and concurrent with, WBRT/SRS. Approximately 14 days following WBRT/SRS: all arms will undergo physical and cognitive testing, and: Arm 1 will begin physical activity intervention. Arm 2 will begin physical activity intervention and cognitive intervention. Arm 3 will continue with cognitive intervention and begin physical activity intervention. All Arms will undergo physical and cognitive testing approximately 2.5 months post WBRT/SRS.

All participants will be blinded to the study design and will be randomized into one of three treatment arms. Research assistant is blinded to both the study design and to which arm the participants are randomized.

Impact of Cognitive Rehab and Physical Activity on Cognition in Patients With Metastatic Brain Tumors Undergoing RT

Does Cognitive Rehabilitation and Physical Activity Impact Executive Functioning Following Radiation Therapy for Cerebral Metastases? A Pilot Study

Recruitment: success defined as enrollment rate of 19% of eligible subjects.

Retention: success defined as retention rate above 56% at end-of-study.

Participant missed or cancelled therapy sessions less than 15% of time.

Participant completed full scheduled minutes per session ≥ 80% of time.

Participant completed ≥ 80% of PA interventions (required \< 20% rest period during or between tasks).

Participant completed ≥ 80% of CR interventions (required \< 20% rest period during or between tasks).

Composite score post-CR intervention, minus the composite score at baseline. Scores of zero indicates maintained cognition. Positive scores indicate improved cognition. Negative scores indicate declined cognition. Composite scores derived from the following four standardized tests:

* The Stroop Color Word Test (SCWT) is a 3-part measure that tests the executive function area of attention.
* The Trail Making Test (TMT) is a 2-part measure that tests the executive function area of complex attention.
* The Rey Auditory Verbal Learning Test (AVLT) is a 6-part measure that tests the executive function area of memory.
* The Clock Drawing Test (CDT) is a single measure that tests the executive function area of visuospatial relationships and praxis.

Composite scores post intervention minus scores at baseline. Scores of zero indicate maintained physical abilities. Positive scores indicate improved physical abilities. Negative scores indicate declined physical abilities. Composite scores derived from the following two standardized tests:

* The Timed Up and Go (TUG) is a single measure that tests mobility, balance, and walking ability.
* The 30-second Chair Stand Test (30sCST) is a single measure that tests functional lower body strength.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Cavity Boost Radiation Therapy vs. Observation in Cerebral Metastases After Complete Surgical Resection	NCT02887651	Cerebral Metast... Surgery	Cavity boost ra...	18 Years -	Heinrich-Heine University, Duesseldorf
Prospective Study on Oncologic Cerebral Imagery Contribution by 18F-FDOPA Position Emission Tomography (PET)	NCT02022800	Glioma Cerebral Metast...	PET 18FDOPA	18 Years - 85 Years	Centre Antoine Lacassagne
Evaluation of Resection Quality of Cerebral Metastases Using Fluorescence Guided Surgery: a Prospective Randomised Study	NCT04116801	Cerebral Metast... Fluorescence Gu...	microsurgical r...	18 Years - 85 Years	Ramsay Générale de Santé
Whole-Brain Radiotherapy (WBRT) Versus WBRT and Integrated Boost Using Helical Tomotherapy for Multiple Brain Metastases	NCT00876759	Brain Metastase...	whole brain rad... whole brain rad...	18 Years -	University Hospital, Essen
Evaluation of Resection Quality of Cerebral Metastases Using Fluorescence Guided Surgery: a Prospective Randomised Study	NCT04116801	Cerebral Metast... Fluorescence Gu...	microsurgical r...	18 Years - 85 Years	Ramsay Générale de Santé
Evaluation of Resection Quality of Cerebral Metastases Using Fluorescence Guided Surgery: a Prospective Randomised Study	NCT04116801	Cerebral Metast... Fluorescence Gu...	microsurgical r...	18 Years - 85 Years	Ramsay Générale de Santé
Predictive Value of Dynamic Contrast Enhancement MRI on a Cerebral Tumor Response to Gamma Knife Treatment	NCT00156585	Cerebral Metast...		18 Years -	Université de Sherbrooke
Therapeutic Strategies in Patients With Non-squamous Non-small Cell Lung Cancer With Brain Metastases	NCT02162537	Non-small Cell ... Non-small Cell ... Adenocarcinoma ... Cerebral Metast...	Cisplatin Pemetrexed Bevacizumab Cerebral Radiot...	18 Years -	Centre Hospitalier Intercommunal Creteil
Impact of Cognitive Rehab and Physical Activity on Cognition in Patients With Metastatic Brain Tumors Undergoing RT	NCT03096431	Metastatic Brai... Cerebral Metast...	Physical Activi... Cognitive rehab...	18 Years -	Virginia Commonwealth University

Spots Global Cancer Trial Database for cerebral metastases