Study: Stereotactic radiosurgery preferred treatment for brain tumor
Patients given whole-brain radiotherapy (WBRT) are at greater risk of decline in learning and memory function; therefore, stereotactic radiosurgery (SRS) plus close clinical monitoring should be the standard initial treatment, according to results of a clinical trial published online Oct. 3, before the November edition of Lancet Oncology.
Patients with brain tumors are currently treated with SRS, with or without WBRT, but to date it has been unclear whether the addition of WBRT outweighed the risks, according to Eric L. Chang, MD, at the University of Texas M. D. Anderson Cancer Center in Houston, and colleagues.
In this controlled trial, researchers randomly assigned patients with one to three newly diagnosed brain metastases to SRS plus WBRT (28 patients) or SRS alone (30) between 2001 and 2007.
The primary endpoint was neurocognitive function: objectively measured as a significant deterioration (five-point drop compared with baseline) in an assessment called the Hopkins Verbal Learning Test—Revised l(HVLT-R) at four months.
After these 58 patients were recruited, the trial was stopped because there was a high probability (96 percent) that patients randomly assigned to receive SRS plus WBRT were significantly more likely to show a decline in learning and memory function at four months than were patients assigned to receive SRS alone, the investigators reported.
Patients randomly assigned to SRS plus WBRT were more likely to show a significant drop in HVLT-R total recall at four months than were patients randomly assigned to SRS alone (52 vs. 24 percent, respectively), despite the fact that patients in the SRS alone group showed a higher overall brain tumor recurrence rate than did those patients in the SRS plus WBRT group, the researchers said. This finding persisted at six-month follow up.
At four months there were four deaths (13 percent) in the group that received SRS alone, and eight deaths (29 percent) in the group that received SRS plus WBRT. According to the authors, 73 percent of patients in the SRS plus WBRT group were free from recurrence at one year, compared with 27 percent of patients who received SRS alone.
Despite this difference in recurrence, the authors advised against WBRT because it “causes more of decline in brain function.” When tumors recur, they could be effectively managed with surgery if spotted early through regular monitoring, with a much lower decline in brain function than is seen in those patients receiving WBRT upfront.
Based on the results, the authors wrote that “[a]pplicability of the findings is dependent on the willingness of patients and their physicians to adhere to a schedule of close monitoring, having consistent access to high-quality MRI, having access to a neurosurgical team willing and able to perform salvage resections when indicated, and applying strict physics quality-assurance procedures for SRS.”
According to Chang and colleagues, their study provides “level-1 evidence to support the use of SRS alone in the initial management of patients newly diagnosed with one to three brain metastases. We recommend that initial SRS alone combined with close clinical monitoring should be the preferred treatment strategy for such patients.”
Patients with brain tumors are currently treated with SRS, with or without WBRT, but to date it has been unclear whether the addition of WBRT outweighed the risks, according to Eric L. Chang, MD, at the University of Texas M. D. Anderson Cancer Center in Houston, and colleagues.
In this controlled trial, researchers randomly assigned patients with one to three newly diagnosed brain metastases to SRS plus WBRT (28 patients) or SRS alone (30) between 2001 and 2007.
The primary endpoint was neurocognitive function: objectively measured as a significant deterioration (five-point drop compared with baseline) in an assessment called the Hopkins Verbal Learning Test—Revised l(HVLT-R) at four months.
After these 58 patients were recruited, the trial was stopped because there was a high probability (96 percent) that patients randomly assigned to receive SRS plus WBRT were significantly more likely to show a decline in learning and memory function at four months than were patients assigned to receive SRS alone, the investigators reported.
Patients randomly assigned to SRS plus WBRT were more likely to show a significant drop in HVLT-R total recall at four months than were patients randomly assigned to SRS alone (52 vs. 24 percent, respectively), despite the fact that patients in the SRS alone group showed a higher overall brain tumor recurrence rate than did those patients in the SRS plus WBRT group, the researchers said. This finding persisted at six-month follow up.
At four months there were four deaths (13 percent) in the group that received SRS alone, and eight deaths (29 percent) in the group that received SRS plus WBRT. According to the authors, 73 percent of patients in the SRS plus WBRT group were free from recurrence at one year, compared with 27 percent of patients who received SRS alone.
Despite this difference in recurrence, the authors advised against WBRT because it “causes more of decline in brain function.” When tumors recur, they could be effectively managed with surgery if spotted early through regular monitoring, with a much lower decline in brain function than is seen in those patients receiving WBRT upfront.
Based on the results, the authors wrote that “[a]pplicability of the findings is dependent on the willingness of patients and their physicians to adhere to a schedule of close monitoring, having consistent access to high-quality MRI, having access to a neurosurgical team willing and able to perform salvage resections when indicated, and applying strict physics quality-assurance procedures for SRS.”
According to Chang and colleagues, their study provides “level-1 evidence to support the use of SRS alone in the initial management of patients newly diagnosed with one to three brain metastases. We recommend that initial SRS alone combined with close clinical monitoring should be the preferred treatment strategy for such patients.”