From: Subject: Study compares treatment options for patients with brain metastases Date: Wed, 7 Jun 2006 12:03:03 +0200 MIME-Version: 1.0 Content-Type: multipart/related; type="text/html"; boundary="----=_NextPart_000_0009_01C68A2A.5496B420" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2900.2869 This is a multi-part message in MIME format. ------=_NextPart_000_0009_01C68A2A.5496B420 Content-Type: text/html; charset="Windows-1252" Content-Transfer-Encoding: quoted-printable Content-Location: http://www.eurekalert.org/pub_releases/2006-06/jaaj-sct060106.php Study compares treatment options for patients with = brain metastases

Public = release date:=20 6-Jun-2006
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Contact: Hidefumi Aoyama, M.D., Ph.D.
h-aoyama@umin.ac.jp
JAMA and Archives=20 Journals

Study compares treatment options for patients with = brain=20 metastases

Adding whole-brain radiation therapy to = highly-focused=20 radiation therapy does not improve survival for patients with cancer and = brain=20 metastases, but it may reduce the likelihood of the recurrence of brain=20 metastases, according to a study in the June 7 issue of JAMA.=20

Brain metastases (lesions in the brain due to spread of cancers = occurring=20 elsewhere) occur in 20 percent to 40 percent of all patients with cancer = and are=20 generally associated with a poor prognosis, according to background = information=20 in the article. It has been believed that in brain metastases, the = entire brain=20 is "seeded" with micrometastatic disease, even when only a single = intracranial=20 lesion is detected. Consequently, whole-brain radiation therapy (WBRT), = which=20 has possible adverse effects, has been the dominant treatment. Recently, = the=20 assumption that the entire brain is seeded with micrometastases has been = questioned. For patients who truly have limited intracranial disease, = the=20 potential exists that WBRT could be replaced by more focused therapeutic = options=20 such as resection (partial surgical removal) or stereotactic = radiosurgery (SRS),=20 which delivers high-dose, focal radiation, with less long-term adverse = effects=20 than WBRT. These therapies have been used with increasing frequency. It = has been=20 unclear whether adding WBRT to SRS improves survival or neurologic = function=20 compared with SRS alone.=20

Hidefumi Aoyama, M.D., Ph.D., of Hokkaido University Graduate School = of=20 Medicine, Sapporo, Japan, and colleagues conducted a randomized = controlled trial=20 comparing WBRT plus SRS vs. SRS alone for patients with limited (defined = as 4 or=20 less) brain metastases. The study included 132 patients enrolled at 11 = hospitals=20 in Japan between October 1999 and December 2003. Patients were randomly = assigned=20 to receive WBRT plus SRS (65 patients) or SRS alone (67 patients).=20

The researchers found that the median (midpoint) survival time and = the 1-year=20 actuarial (calculated) survival rate were 7.5 months and 38.5 percent in = the=20 WBRT + SRS group and 8.0 months and 28.4 percent for SRS alone. The = 12-month=20 brain tumor recurrence rate was 46.8 percent in the WBRT + SRS group and = 76.4=20 percent for SRS alone group. Salvage (treatment after other measures = have been=20 unsuccessful) brain treatment was less frequently required in the WBRT + = SRS=20 group (n =3D 10) than with SRS alone (n =3D 29). Death was attributed to = neurologic=20 causes in 22.8 percent of patients in the WBRT + SRS group and in 19.3 = percent=20 of those treated with SRS alone. There were no significant differences = in=20 systemic and neurologic functional preservation and toxic effects of = radiation.=20

"In conclusion, our findings demonstrated that SRS alone without = up-front=20 WBRT was associated with increased brain tumor recurrence; however, it = did not=20 result in either worsened neurologic function or increased risk of = neurologic=20 death. With respect to patient survival, the control of systemic cancer = might=20 outweigh the frequent recurrence of brain tumors. Therefore, SRS alone = could be=20 a treatment option, provided that frequent monitoring of brain tumor = status is=20 conducted," the authors write.=20

###

(JAMA. 2006;295:2483-2491. Available pre-embargo to the media at http://www.jamamedia.org/)=20

Editorial: Radiosurgery and Whole-Brain Radiation Therapy for = Brain=20 Metastases - Either or Both as the Optimal Treatment=20

In an accompanying editorial, Jeffrey Raizer, M.D., of the Feinberg = School of=20 Medicine, Northwestern University, Chicago, comments on the study = concerning=20 treatment for brain metastases.=20

"How should clinicians interpret the findings reported by Aoyama et = al and=20 the data available in the literature? Patients who have more than 4 = brain=20 metastases should continue to be treated with WBRT. For patients with 4 = or fewer=20 brain metastases, the combination of stereotactic radiosurgery and WBRT = improves=20 local brain control but does not affect survival. Therefore, either mode = is a=20 reasonable first choice =85 Whether overall quality of life is = positively or=20 negatively affected is unknown, but for patients who might be cured of = their=20 cancer, omitting WBRT could avoid long-term neurotoxic effects."=20

(JAMA. 2006;295:2535-2536. Available pre-embargo to the media at http://www.jamamedia.org/)=20

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