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Stereotactic Radiosurgery Preferred for Brain Metastases
Cancer Newsline - Fall 2009
Less Risk of Developing Learning, Memory Problems
Cancer patients who receive stereotactic radiosurgery (SRS) and whole brain radiation therapy (WBRT) to treat 1-3 metastatic brain tumors have more than twice the risk of developing learning and memory problems than those treated with SRS alone.
Findings from a Phase III randomized study led by M. D. Anderson researchers were published in the Oct. 5 online edition of The Lancet Oncology.
Significance of study
The study supports the use of SRS alone, combined with close monitoring, as the initial treatment strategy for cancer patients newly diagnosed with 1-3 brain metastases (tumors that have spread to the brain from other areas of the body).
“Though both approaches are commonly practiced in the United States, these findings allow radiation oncologists to recommend the SRS plus close clinical monitoring as the optimal form of treatment for this group of patients,” says study leader Eric Chang, Ph.D., associate professor in the Department of Radiation Oncology at M. D. Anderson. “This method is consistent with the trend of personalized medicine and tailoring therapies, rather than applying the one-size-fits-all approach of giving WBRT to all patients with brain metastases.”
Background
Over the last decade SRS, which uses high doses of targeted X-rays, has gained acceptance as an initial treatment for tumors that have spread to the brain. SRS also is commonly used in combination with WBRT, radiation of the entire brain, to treat tumors that are visible and those that may not be detected by diagnostic imaging.
The American Cancer Society estimates that approximately 170,000 cancer patients will have metastases to the brain from common primary cancers such as breast, colorectal, kidney and lung in 2009. More than 80,000 of these patients will have 1-3 brain metastases.
Research methods
The seven-year study observed 58 patients with 1-3 newly diagnosed brain metastases who received either:
- SRS followed by WBRT
- SRS alone
Primary results
Approximately four months after treatment, there was a decline in learning and memory function in:
- 52% of patients who received SRS plus WBRT
- 24% of patients who received SRS alone
The study ended after interim results showed a high statistical probability (96.4%) that patients receiving SRS alone would continue to perform better.
Additional results
Researchers found that after one year, there was no sign of active cancer in the brain for:
- 73% of patients who received SRS plus WBRT
- 27% of patients who received SRS alone
“Despite this difference in recurrence rates, we would still advise against routinely giving WBRT because according to our study, patients treated with SRS plus WBRT were at greater risk of a significant decline in learning and memory function by four months compared with the group that received SRS alone,” Chang says. “With close monitoring, salvage resections or additional radiation can be performed as necessary, and patients who receive SRS alone will fare better with their quality of life intact.”
What’s next?
Based on these results, future research studies will look for additional evidence that using SRS alone is the best approach for patients with more than three brain metastases.
Adapted by David Berkowitz from an M. D. Anderson News Release.
M. D. Anderson resources:
Division of Radiation Oncology
Additional resources:
Brain tumors (National Cancer Institute)
Brain tumors (American Cancer Society)
Stereotactic radiosurgery (Radiological Society of North America)