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Stereotactic radiosurgery alone might be best for certain patients with metastatic brain tumors

por Lauren Dubinsky, Senior Reporter | August 02, 2016
Rad Oncology Radiation Therapy
The less radiation, the better — in the case of patients with three or fewer metastatic brain tumors. Researchers from Mayo Clinic found that when those patients receive treatment with stereotactic radiosurgery (SRS), they had less cognitive deterioration three months after treatment than patients who received SRS combined with whole brain radiation therapy (WBRT).

About 30 percent of patients with cancer develop brain metastases and the incidence of these lesions is growing. The majority of patients have limited intracranial metastases, which is usually one to three brain lesions.

For the study, the researchers recruited 213 patients, around the age of 61 years and with one to three brain metastases, from 34 institutions in North America. They were randomly assigned to receive SRS alone or SRS and WBRT.

The patients’ rate of cognitive decline was measured at the start of the study and then again after three months. Quality of life, functional independence, long-term cognitive status and overall survival were also assessed. The researchers found that the patients who received SRS alone had less cognitive deterioration at three months, compared to the patients who also received WBRT. The SRS only group also had a higher quality of life at the three-month mark.

On average, the patients who received SRS alone survived three months longer than those who also received WBRT. However, there wasn’t a significant difference in function independence between the two groups.

Furthermore, for long-term survivors, cognitive deterioration was less after SRS alone at three months and also at 12 months.

WBRT is known to greatly improve tumor control in the brain after SRS, but because it’s associated with cognitive decline, its role in treating patients with brain metastases is controversial. However, this study may have put an end to the controversy.

"The debate between WBRT and SRS has been resolved for the specific type of patient (with 1-3 metastases) who enrolled in the current study, and there is little role for WBRT for these patients," Dr. Carey K. Anders of the University of North Carolina at Chapel Hill and colleagues wrote in an accompanying editorial.

But the researchers caution that the results of the study don’t prove that SRS is the standard for patients with four or more metastases or that WBRT no longer should be used to treat brain metastases. WBRT may still be necessary for treating patients who don’t have one to three brain metastases.

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