Whole-brain radiation for mets may be ineffective

Patients with a limited number of brain metastases and stable primary cancer who receive whole-brain radiation therapy after surgery do not have better survival outcomes than patients who don't receive the treatment, according to results presented this week at the meeting of the European Cancer Organization (ECCO) and the European Society for Medical Oncology (ESMO) in Berlin.

Whole-brain radiation therapy is sometimes used to slow or prevent cancer recurrence after conventional surgery or radiosurgery in patients with a limited number of brain metastases. But principal investigator Dr. Riccardo Soffietti said that use of the technique for this indication does not improve several key patient outcomes and can damage a patient's cognitive functions, in some cases leading to dementia in long-surviving patients.

In a phase III randomized clinical trial, Soffietti, from the University of Torino in Italy, and colleagues followed the clinical and survival outcomes of 353 patients. Half of the group received whole-brain radiotherapy after surgery or radiosurgery, and the other half did not.

There was no statistically significant difference in overall survival. Median survival was 10.9 months for the group that did not receive whole-brain radiation therapy and 10.7 months for those who did.

In addition, there was no statistically significant difference in the length of time that patients were able to function independently. The group receiving whole-brain radiation therapy had a median of 9.5 months of independent living, compared with 10 months for the patients who did not receive the treatment.

But whole-brain radiation therapy did reduce the likelihood that cancer would spread to other areas of the brain. At two years, cancer had progressed in 31.2% of patients who received whole-brain radiation therapy, compared with 54.2% of the patients who did not receive the treatment. Brain tumor progression killed 25% of the patients in the whole-brain radiotherapy group and 43% in the other group.

Radiotherapy treatments also slowed the progression of cancer on average by five weeks, with 4.6 months for the treatment group versus 3.4 months for the other group.

Soffietti said that although there are some advantages to whole-brain radiotherapy after conventional surgery or radiosurgery, it showed no benefit in terms of the key outcomes of treatment: survival and independent living. He noted that new radiation techniques that spare areas of the brain involved in cognitive functions might offer different outcomes.

Related Reading

Stereotactic radiosurgery adequate for treating brain metastases, January 7, 2009

Physicians overestimate benefits of palliative whole brain radiotherapy, September 23, 2008

Whole brain radiation does not improve upon stereotactic radiation, June 8, 2006

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