The survival rate of selected patients with cancer that has spread to the brain (brain metastases) is improved by more than 33 percent when they are treated with whole brain radiation followed by stereotactic radiosurgery, according to research published in the current issue of The Lancet.
“This is a significant study because brain metastases occur in up to 40 percent of cancer patients and their prognosis is generally poor,” said Edward Shaw, M.D., chairman of Radiation Oncology at Wake Forest University Baptist Medical Center.
Stereotactic radiosurgery (SRS) is a technique that involves a single treatment of high-dose radiation precisely focused at the brain metastasis. Wake Forest Baptist has the only Gamma Knife stereotactic radiosurgery unit in North Carolina. In current practice, SRS is frequently prescribed as a less invasive alternative to surgery for the treatment of brain metastases.
In this trial, patients with one to three brain metastases were randomized to receive 15 treatments of whole brain radiation therapy (WBRT) with or without SRS to their brain metastases. Study data show an improvement in survival from 4.9 months to 6.5 months for patients with a single brain metastasis treated with WBRT plus SRS. Patients with multiple brain metastases treated with the addition of SRS did not show a statistically significant improvement in survival, but they were more likely to show an improvement in their performance status, a quality of life measure, with no increase in treatment side effects.
The research was coordinated by the Radiation Therapy Oncology Group (RTOG), a multi-institutional international clinical cooperative group funded primarily by the National Cancer Institute. Wake Forest Baptist was one of 55 RTOG member institutions that enrolled a total of 333 patients between January 1996 and June 2001.
“These are the first prospective randomized data addressing radiosurgery for the treatment of brain metastases, and we were pleased to demonstrate that radiosurgery actually provides a therapeutic benefit for patients with a single brain metastasis,” said study first author David W. Andrews, M.D., professor of Neurosurgery at Thomas Jefferson University. “We have demonstrated survival benefit and a better quality of life after radiosurgery. We hope this analysis will provide practicing oncologists with more treatment options when confronted with this challenging problem.”
“This trial has changed the practice pattern for patients with one to three inoperable brain metastases. Given the demonstrated improved performance of all patients treated on this trial with the radiosurgery boost, this should be the standard of care for this patient population,” said Walter J. Curran, Jr., M.D., senior author of the study and RTOG chairman and clinical director of the Kimmel Cancer Center at Thomas Jefferson University.
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About Wake Forest University Baptist Medical Center: Wake Forest Baptist is an academic health system comprised of North Carolina Baptist Hospital and Wake Forest University School of Medicine. It is licensed to operate 1,282 acute care, psychiatric, rehabilitation and long-term care beds and is consistently ranked as one of “America’s Best Hospitals” by U.S. News & World Report.
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