***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND To determine the protective effects of memantine on cognitive function in patients receiving whole-brain radiotherapy ( WBRT ) . METHODS Adult patients with brain metastases received WBRT  and were r and omized to receive placebo or memantine ( 20 mg/d ) , within 3 days of initiating radiotherapy for 24 weeks . Serial st and ardized tests of cognitive function were performed . RESULTS Of 554 patients who were accrued , 508 were eligible . Grade 3 or 4 toxicities and study compliance were similar in the 2 arms . There was less decline in delayed recall in the memantine arm at 24 weeks ( P = .059 ) , but the difference was not statistically significant , possibly because there were only 149 analyzable patients at 24 weeks , result ing in only 35 % statistical power . The memantine arm had significantly longer time to cognitive decline ( hazard ratio 0.78 , 95 % confidence interval 0.62 - 0.99 , P = .01 ) ; the probability of cognitive function failure at 24 weeks was 53.8 % in the memantine arm and 64.9 % in the placebo arm . Superior results were seen in the memantine arm for executive function at 8 ( P = .008 ) and 16 weeks ( P = .0041 ) and for processing speed ( P = .0137 ) and delayed recognition ( P = .0149 ) at 24 weeks . CONCLUSIONS Memantine was well tolerated and had a toxicity profile very similar to placebo . Although there was less decline in the primary endpoint of delayed recall at 24 weeks , this lacked statistical significance possibly due to significant patient loss . Overall , patients treated with memantine had better cognitive function over time ; specifically , memantine delayed time to cognitive decline and reduced the rate of decline in memory , executive function , and processing speed in patients receiving WBRT . RTOG 0614 , Clinical Trials.gov number CT00566852 PURPOSE Prophylactic cranial irradiation ( PCI ) in patients with extensive-disease small-cell lung cancer ( ED-SCLC ) leads to significantly fewer symptomatic brain metastases and improved survival . Detailed effects of PCI on health-related quality of life ( HRQOL ) are reported here . PATIENTS AND METHODS Patients ( age , 18 to 75 years ; WHO < or = 2 ) with ED-SCLC , and any response to chemotherapy  , were r and omly assigned to either observation or PCI .  Health-related quality of life ( HRQOL ) and patient-reported symptoms were secondary end points . The European Organisation for the Research and Treatment of Cancer core HRQOL tool ( Quality of Life Question naire C30 ) and brain module ( Quality of Life Question naire Brain Cancer Module ) were used to collect self-reported patient data . Six HRQOL scales were selected as primary HRQOL end points : global health status ; hair loss ; fatigue ; and role , cognitive and emotional functioning . Assessment s were performed at r and om assignment , 6 weeks , 3 months , and then 3-monthly up to 1 year and 6-monthly thereafter . RESULTS Compliance with the HRQOL assessment was 93.7 % at baseline and dropped to 60 % at 6 weeks . Short-term results up to 3 months showed that there was a negative impact of PCI on selected HRQOL scales . The largest mean difference between the two arms was observed for fatigue and hair loss . The impact of PCI on global health status as well as on functioning scores was more limited . For global health status , the observed mean difference was eight points on a scale 0 to 100 at 6 weeks ( P = .018 ) and 3 months ( P = .055 ) . CONCLUSION PCI should be offered to all responding ED SCLC patients . Patients should be informed of the potential adverse effects from PCI . Clinicians should be alert to these ; monitor their patients ; and offer appropriate support , clinical , and psychosocial care PURPOSE To assess the impact of prophylactic cranial irradiation ( PCI ) on self-reported cognitive functioning ( SRCF ) , a functional scale on the European Organization for Research and Treatment of Cancer Core Quality of Life Question naire ( EORTC QLQ-C30 ) . METHODS AND MATERIAL S Radiation Therapy Oncology Group ( RTOG ) protocol 0214 r and omized patients with locally advanced non-small cell lung cancer to PCI or observation ; RTOG 0212 r and omized patients with limited-disease small cell lung cancer to high- or st and ard-dose PCI .  In both trials ,  Hopkins Verbal Learning Test (HVLT)-Recall and -Delayed Recall and SRCF were assessed at baseline ( after locoregional therapy but before PCI or observation ) and at 6 and 12 months . Patients developing brain relapse before follow-up evaluation were excluded . Decline was defined using the reliable change index method and correlated with receipt of PCI versus observation using logistic regression modeling . Fisher 's exact test correlated decline in SRCF with HVLT decline . RESULTS Of the eligible patients pooled from RTOG 0212 and RTOG 0214 , 410 ( 93 % ) receiving PCI and 173 ( 96 % ) undergoing observation completed baseline HVLT or EORTC QLQ-C30 testing and were included in this analysis . Prophylactic cranial irradiation was associated with a higher risk of decline in SRCF at 6 months ( odds ratio 3.60 , 95 % confidence interval 2.34 - 6.37 , P<.0001 ) and 12 months ( odds ratio 3.44 , 95 % confidence interval 1.84 - 6.44 , P<.0001 ) . Decline on HVLT-Recall at 6 and 12 months was also associated with PCI ( P=.002 and P=.002 , respectively ) but was not closely correlated with decline in SRCF at the same time points ( P=.05 and P=.86 , respectively ) . CONCLUSIONS In lung cancer patients who do not develop brain relapse , PCI is associated with decline in HVLT-tested and self-reported cognitive functioning . Decline in HVLT and decline in SRCF are not closely correlated , suggesting that they may represent distinct elements of the cognitive spectrum PURPOSE Neurotoxic effects of brain irradiation include cognitive impairment in 50 % to 90 % of patients . Prior studies have suggested that donepezil , a neurotransmitter modulator , may improve cognitive function . PATIENTS AND METHODS A total of 198 adult brain tumor survivors ≥ 6 months after partial- or whole-brain irradiation were r and omly assigned to receive a single daily dose ( 5 mg for 6 weeks , 10 mg for 18 weeks ) of donepezil or placebo . A cognitive test battery assessing memory , attention , language , visuomotor , verbal fluency , and executive functions was administered before r and om assignment and at 12 and 24 weeks . A cognitive composite score ( primary outcome ) and individual cognitive domains were evaluated . RESULTS Of this mostly middle-age , married , non-Hispanic white sample , 66 % had primary brain tumors , 27 % had brain metastases , and 8 % underwent prophylactic cranial irradiation . After 24 weeks of treatment , the composite scores did not differ significantly between groups ( P = .48 ) ; however , significant differences favoring donepezil were observed for memory ( recognition , P = .027 ; discrimination , P = .007 ) and motor speed and dexterity ( P = .016 ) . Significant interactions between pretreatment cognitive function and treatment were found for cognitive composite ( P = .01 ) , immediate recall ( P = .05 ) , delayed recall ( P = .004 ) , attention ( P = .01 ) , visuomotor skills ( P = .02 ) , and motor speed and dexterity ( P < .001 ) , with the benefits of donepezil greater for those who were more cognitively impaired before study treatment . CONCLUSION Treatment with donepezil did not significantly improve the overall composite score , but it did result in modest improvements in several cognitive functions , especially among patients with greater pretreatment impairments 
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RESULTS Steroids provide relief of symptoms due to intra-cerebral edema .
The steroid of choice is dexamethasone .
Surgery or radiosurgery improves survival for selected patients with single brain metastasis as compared to WBRT alone .