LEXINGTON, KY (Nov. 3, 1998) -- University of Kentucky Chandler Medical Center researchers have shown that surgical treatment plus radiation therapy is superior to surgery alone in the treatment of the most common type of brain tumors. The results of the randomized trial are published in the Nov. 4 Journal of the American Medical Association (JAMA).
Metastatic brain tumors are tumors that arise in organs other than the brain and later spread to the brain. These brain tumors occur in about 25 percent of all patients with cancer and are a significant cause of suffering and death in cancer patients.
"Death due to brain cancer involves the inexorable loss of mental and physical abilities, and is the most difficult type of death with which patients and their families have to cope," said Roy Patchell, M.D., a UK neuro-oncologist and associate professor of surgery and neurology, UK College of Medicine. "We are attempting to reduce the suffering that these patients must go through." The goal of treatment of brain metastasis is to eliminate the tumor in the brain and prevent recurrence, Patchell said. UK researchers believed that the addition of radiation therapy would help eradicate microscopic cells that were undetected at the time of surgery. They enrolled 95 patients with brain metastases. All were treated with surgery and were examined by magnetic resonance imaging, an accurate type of brain scan, to rule out other areas of cancer in the brain. Patients randomly were assigned to treatment with postoperative radiation or no further treatment.
Patients in the radiation group received daily doses of radiation beginning 28 days after surgery. Radiation treatments continued for five and a half weeks. The brain MRI scans were repeated for all patients at three-month intervals for the first year after treatment and every six months thereafter.
To decide which treatment was better, researchers evaluated the length of survival, presence of tumor recurrence in the brain, length of time to brain recurrence, and the cause of death of patients.
"The addition of postoperative radiotherapy resulted in substantially better control of the brain tumor than with only surgery," Patchell said. "Patients receiving radiation had significantly less recurrence of tumor in the brain, and even when they did have brain tumor recurrence, it usually occurred later than in the group that did not receive radiation."
The addition of radiation prevented patients from dying as a direct result of their brain tumors. Only 14 percent of patients in the radiation group died of neurologic causes compared to 44 percent in the group that did not receive radiation. Despite the reduction in brain recurrence rates and death due to neurologic causes, postoperative radiotherapy did not result in increased overall survival or improvement in the length of time that patients were able to independently function.
Other UK researchers contributing to the study were: Phillip Tibbs, M.D., professor of surgery and rehabilitation medicine, UK College of Medicine, and director of the UK Spine Center; William Regine, M.D., associate professor of radiation medicine, UK College of Medicine; Robert Dempsey, M.D., professor of neurological surgery, University of Wisconsin Medical School; Mohammed Mohiuddin, M.D., professor and chair of radiation medicine, UK College of Medicine; Richard Kryscio, Ph.D., professor and chair, department of statistics, UK and director of the Biostatistics Consulting Unit, UK Chandler Medical Center; William Markesbery, M.D., professor of neurology and pathology, UK College of Medicine and director of the Sanders-Brown Center on Aging; Kenneth Foon, M.D., professor of medicine, UK College of Medicine, chief of hematology and oncology and director of the UK Markey Cancer Center; and Johnston-Wright Chair Byron Young, M.D., professor and chief of neurosurgery.
MEDIA NOTE:
THIS INFORMATION IS EMBARGOED UNTIL 4 P.M., TUESDAY, NOV. 3, 1998
Journal
JAMA