In as many as one-third of all patients with lung and breast cancers, the disease spreads to the brain, leaving few good options. The disease causes neurological problems, and many patients live only about four months. Chemotherapy has been relatively ineffective in shrinking tumors and improving quality of life. "It's a substantial problem and progress in their management has been quite slow," says Walter Curran, Jr., M.D., professor and chair of radiation oncology at Jefferson Medical College of Thomas Jefferson University in Philadelphia and clinical director of Jefferson's Kimmel Cancer Center.
The standard treatment is two to three weeks of whole brain radiation, which helps improve neurological function and quality of life. Between 1996 and 2001, researchers at Jefferson Medical College and elsewhere randomly assigned 333 patients to receive either whole brain radiation therapy alone, or whole brain radiation therapy followed by stereotactic radiosurgery. The latter, used to treat benign tumors, entails delivering radiation to specific areas of the brain while sparing healthy tissue.
They found that patients with a single brain metastases who received radiosurgery immediately after whole brain radiation lived on average one to two months longer. Those with two or three brain metastases who had "good performance status" had some improvement in survival as well, says Dr. Curran. Those without a "good activity level" didn't do as well. His team presents its results October 7, 2002, at the American Society for Therapeutic Radiology and Oncology's Annual Meeting in New Orleans.
"It's the first time any trial using non-operative therapy has shown a survival advantage in these patients," Dr. Curran, who is chairman of the Radiation Therapy Oncology Group, a federally funded cancer clinical trials group which carries out multi-disciplinary research nationwide and which conducted the study.
"We had no evidence whether or not using it at the time of diagnosis would be beneficial. The only time we've shown survival advantage before was surgical removal. Now, for the first time, something that is not an operation makes a difference.
"Intuitively, it makes sense," he says. "Because this has been such a difficult group for which to change survival, we found it gratifying that we could show a positive result." The researchers hope to be able to add medications to the treatment program to further improve survival.
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