Dr. @Vinai Gondi and I put together the response below:We use memantine and hippocampal sparing technique for all brain metastasis patients who are planning to receive WBRT. This is based off the recently published phase III trial NRG CC001 that found hippocampal avoidance WBRT plus memantine result...

For years we have significantly reduced the routine use of whole brain radiotherapy. We have used hippocampal sparing in a few of the patients when appropriate. However, since they were not treated on any clinical protocol, routine formal neuro-cognitive evaluation was not performed. I have tried me...

After the recent publication of the NRG Oncology CC001 trial, for most patients receiving WBRT, we incorporate memantine and hippocampal avoidance. The randomized data are self-explanatory and practice-changing.

We often give memantine with WBRT based on the RTOG 0614 results. Though the primary endpoint (delayed recall at 24 weeks) was not significant, likely due to the number of analyzable patients being low at this time point, the overall difference in time to cognitive decline was significant. Other sec...

Unfortunately not all insurance companies have adopted it as part of their guidelines, and it is still challenging with some.  Also expected survival is important, as somebody with an expected survival of 3-4 months may not see the benefit of hippocampal sparing techniques.

I'd be curious to know--has anyone faced pre-authorization denials from insurance companies in covering HA-WBRT? Memantine is easy as it's gone generic and 3rd party payers are covering it.

I find it uncomfortable to decide who we should attempt cognitive-sparing HA on and who we shouldn't. I tend to feel that if we think it is appropriate to treat them at all, then it is appropriate to do so in a way that spares brain function.