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Title: Whole-Brain Irradiation Plus Radiosurgery for New Brain Metastases Impairs Brain Function: Presented at ASTRO
URL: http://www.pslgroup.com/dg/22D706.htm
Doctor's Guide
September 24, 2008

By Martha Kerr, BSN

BOSTON -- September 24, 2008 -- A trial evaluating whole-brain irradiation added to stereotactic radiosurgery for newly diagnosed brain metastases had to be halted prematurely when it was found that the combination significantly impaired memory and learning ability.

Investigators presented the findings from this study in a late-breaking clinical trials session on September 23 at the American Society of Therapeutic Radiology and Oncology (ASTRO) 50th Annual Meeting.

The phase 3 trial involved 58 patients with 1 to 3 brain metastases who were diagnosed within 1 month of enrolment and had no prior history of brain surgery, radiosurgery, or brain irradiation.

Thirty patients received whole-brain irradiation in addition to stereotactic radiosurgery consisting of 30 Gy in 12 fractions within 1 week of radiosurgery, while 28 patients received stereotactic radiosurgery alone.

Neurological examinations, magnetic resonance imaging of the brain, and formal neurocognitive testing were conducted at 1, 2, 4, and 6 months and every 3 months thereafter. Median follow-up for the entire study cohort was 7.5 months.

The trial was halted early when it became evident that patients randomised to whole-brain irradiation plus radiosurgery had a 48% cognitive decline in learning and memory compared with patients randomised to radiosurgery alone, who experienced a 20% cognitive decline, said lead investigator Eric L. Chang, MD, Department of Radiation Oncology, M. D. Anderson Cancer Center, Houston, Texas.

There was 67% rate of local freedom from progression (FFP) at 1 year with radiosurgery and 100% with radiosurgery plus whole-brain irradiation (P = .012). The rate of distant FFP at 1 year was 45% with single therapy and 73% with dual therapy (P = .023).

"Results of this study show that initial stereotactic radiosurgery alone, coupled with close observation, could become the standard of care for patients newly diagnosed with brain metastases to best preserve their neurocognitive function," Dr. Chang said.

"Results of this study could change the practice of how brain metastases are managed in the United States," he concluded.


[Presentation title: Phase III Randomized Clinical Trial of Radiosurgery With or Without Whole Brain Irradiation in Patients Newly Diagnosed With 1 to 3 Brain Metastases.]

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