Optimizing Neurocognition With Whole Brain Radiation Therapy (WBRT) Using Upfront Pulsed Reduced Dose-Rate (PRDR) Technique

Inclusion Criteria

• •1. Age ≥18 years at diagnosis of brain metastases.
• •2. Eastern Cooperative Oncology Group (ECOG) Performance Score of \<2.
• •3. Participants must have a biopsy-proven solid malignancy (histologic proof or unequivocal cytologic proof solid tumor malignancy from either the primary or any metastatic site) with intracranial lesions radiographically consistent with or pathologically proven to be brain metastases.
• •4. Patients who have undergone prior systemic therapy are eligible.
• •5. Life expectancy from extracranial disease greater than six months.
• •6. Patients with measurable brain metastasis.
• •7. Patients may have had prior therapy for brain metastasis, including stereotactic radiosurgery (SRS)and surgical resection. Patients must have completed prior therapy by at least 7 days prior to study enrollment for SRS and at least 14 days for surgical resection
• •8. If an open biopsy is performed, the patient must be at least one-week post-biopsy. This requirement is not necessary for stereotactic biopsies.
• •9. Creatinine clearance is ≥ 30 mL/min.
• •10. Start of PRDR WBRT within two weeks following registration.
• •11. Ability to complete the Neurocognitive Function (NCF) test battery (including people whose primary language is English).
• •12. Patients with previous or other malignancies whose disease is controlled and not impacting ECOG performance or life expectancy.
• •13. Willing and able to give consent and to comply with treatment and follow-up schedule.