JCO: Hypofractionated stereotactic radiotherapy extends lives
Patients who receive hypofractionated stereotactic radiotherapy (H-SRT) for their recurrent brain cancers live longer lives, according to a study published online May 17 in the Journal of Clinical Oncology.
Maria Werner-Wasik, MD, a radiation oncology professor at Jefferson College and co-director of the Stereotactic Radiosurgery Program at Thomas Jefferson University in Philadelphia, and colleagues found that not only does H-SRT increase survival rates, patients who undergo H-SRT don’t suffer from the same kinds of side effects associated with chemotherapies and targeted therapies.
"In many centers, patients with tumor progression within six months after the initial conformal radiotherapy are denied a second radiotherapy course (such as H-SRT), based on the assumption that their prognosis is poor,” said Werner-Wasik. "Our findings support the recommendation that essentially all patients with progressive high-grade gliomas, who are in good shape and have tumors amenable to local radiotherapy, should be considered for H-SRT."
In the study of 147 patients, the authors determined that the median survival when H-SRT was used after cancer progressed was 11 months. This compared to six months after cancer recurrence for patients who underwent the newest targeted therapies.
The researchers determined that the patients who have the longest survival when treated with H-SRT after recurrence are those who are younger, have smaller tumors, and a shorter time between diagnosis and recurrence.
H-SRT uses a stereotactic linear-accelerator-based radiosurgery unit to deliver beams of radiation to tumors while sparing the surrounding tissue. It does this by using both MRI and CT imaging to create a 3D representation of a tumor and the radiation is then delivered in doses that specifically conforms to the tumor. Irradiating just the tumor allows physicians to use higher doses of radiation over shorter periods of time.
"We can give a dose that is 50 percent beyond what has been considered the maximum dose of radiation the brain can tolerate," said study co-author David Andrews, MD, a professor of neurological surgery and co-director of the Stereotactic Radiosurgery Program. "We have learned over a 15-year experience that this dose is not only safe, but has almost doubled survival for these patients."
The treatment can also be given over a shorter period of time—two weeks, as opposed to five or six weeks for standard fractionation, according to the authors. This means, they added, that a shortened treatment course not only benefits patients regarding issues of quality of life and convenience, but is also less costly.
Maria Werner-Wasik, MD, a radiation oncology professor at Jefferson College and co-director of the Stereotactic Radiosurgery Program at Thomas Jefferson University in Philadelphia, and colleagues found that not only does H-SRT increase survival rates, patients who undergo H-SRT don’t suffer from the same kinds of side effects associated with chemotherapies and targeted therapies.
"In many centers, patients with tumor progression within six months after the initial conformal radiotherapy are denied a second radiotherapy course (such as H-SRT), based on the assumption that their prognosis is poor,” said Werner-Wasik. "Our findings support the recommendation that essentially all patients with progressive high-grade gliomas, who are in good shape and have tumors amenable to local radiotherapy, should be considered for H-SRT."
In the study of 147 patients, the authors determined that the median survival when H-SRT was used after cancer progressed was 11 months. This compared to six months after cancer recurrence for patients who underwent the newest targeted therapies.
The researchers determined that the patients who have the longest survival when treated with H-SRT after recurrence are those who are younger, have smaller tumors, and a shorter time between diagnosis and recurrence.
H-SRT uses a stereotactic linear-accelerator-based radiosurgery unit to deliver beams of radiation to tumors while sparing the surrounding tissue. It does this by using both MRI and CT imaging to create a 3D representation of a tumor and the radiation is then delivered in doses that specifically conforms to the tumor. Irradiating just the tumor allows physicians to use higher doses of radiation over shorter periods of time.
"We can give a dose that is 50 percent beyond what has been considered the maximum dose of radiation the brain can tolerate," said study co-author David Andrews, MD, a professor of neurological surgery and co-director of the Stereotactic Radiosurgery Program. "We have learned over a 15-year experience that this dose is not only safe, but has almost doubled survival for these patients."
The treatment can also be given over a shorter period of time—two weeks, as opposed to five or six weeks for standard fractionation, according to the authors. This means, they added, that a shortened treatment course not only benefits patients regarding issues of quality of life and convenience, but is also less costly.