Adding stereotactic radiosurgery - which entails delivering radiation to specific points in the brain while sparing normal tissue - after whole brain radiation therapy helps certain patients with cancer that has spread to the brain live longer, says a new study by researchers at Thomas Jefferson University Hospital in Philadelphia.
In as many as one-third of all patients with lung and breast cancers, the disease spreads, or metastasizes, 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.
Between 1996 and 2001, the Radiation Therapy Oncology Group (RTOG), a federally funded clinical trials group, led by researchers at Jefferson Medical College and elsewhere randomly assigned 333 patients to receive either the standard whole brain radiation therapy alone, or whole brain radiation therapy followed by stereotactic radiosurgery.
The researchers found that patients with a single brain metastases who received radiosurgery immediately after whole brain radiation lived on average one to two months longer. Many of those had an improved quality of life after radiosurgery. Some of those with two or three brain metastases had some improvement in survival as well.
"It's significant because it demonstrates for the first time a therapeutic benefit of stereotactic radiosurgery, which is a widely used technique," says first author David Andrews, M.D., professor of neurosurgery at Jefferson Medical College of Thomas Jefferson University in Philadelphia.
The researchers reported their results May 22, 2004 in the journal The Lancet
"Our results establish a new standard of care for the treating oncologist and provide patients with realistic hope for an improved prognosis and better quality of life after treatment," Dr. Andrews says.
"This is the first non-surgical treatment to show benefit for brain metastases in
any group of patients," says RTOG group chairman Walter J. Curran, Jr., M.D., professor and chair of radiation oncology at Jefferson Medical College and clinical director of Jefferson's Kimmel Cancer Center.
Brain metastases affect as many as 100,000 individuals.
"It's a real advance in the management of patients with brain metastases," says Dr. Curran.
Other study authors include Adam Flanders, M.D., and Maria Werner-Wasik, M.D., Thomas Jefferson University; Charles Scott, Ph.D., American College of Radiology; Paul Sperduto, M.D., Metro Minneapolis CCOP; Laurie Gaspar, M.D., University of Colorado Health Sciences Center; Michael Schell, Ph.D., University of Rochester Cancer Center; William Demas, M.D., Akron City Hospital; Janice Ryu, M.D., University of California, Davis Medical Center; Jean-Paul Bahary, M.D., Notre Dame Hospital/University of Montreal; Louis Souhami, M.D., from McGill University; Marvin Rotman, M.D., SUNY Health Science Center, Brooklyn; and Minesh Mehta, M.D., University of Wisconsin Medical School.
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