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Mayo Clinic radiation oncologist whose trials showed that focused radiosurgery preserves thinking and memory better than whole-brain radiotherapy for brain metastases, and that sparing the hippocampus reduces cognitive harm when whole-brain treatment is needed.
Paul Brown is a radiation oncologist at Mayo Clinic in Rochester who leads the North American cooperative-group trials on brain metastases. He was first author of the 2016 JAMA report of Alliance N0574, which showed less cognitive decline with radiosurgery alone than with radiosurgery plus whole-brain radiotherapy for one to three brain metastases; of the 2017 Lancet Oncology report of N107C, which established postoperative radiosurgery to the surgical cavity; and of the 2020 Journal of Clinical Oncology report of NRG CC001, which showed hippocampal avoidance with memantine reduces cognitive toxicity of whole-brain radiotherapy.
Where whole-brain radiotherapy is still chosen, for many metastases or leptomeningeal disease, hippocampal avoidance with memantine is the recommended technique.
Surgical cavity radiosurgery, rather than whole-brain radiotherapy, follows resection of a brain metastasis in fit patients, part of the broader move away from whole-brain treatment.
Patients with a limited number of brain metastases are treated with radiosurgery alone and surveillance, accepting more new brain lesions in return for preserved cognition.
Shares Mayo Clinic, Brain and spinal cord tumours (all types) and the tags brain, trialist.
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Shares Alliance N0574: radiosurgery alone versus radiosurgery plus whole-brain radiotherapy for one to three brain metastases, Brain metastases (secondary brain tumours), Brain and spinal cord tumours (all types).
Shares the tags radiotherapy, trialist.
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Shares the tags brain, trialist.