Stereotactic Radiosurgery Benefits Patients with Brain Metastases

Adding stereotactic radiosurgery after whole brain radiation therapy improves survival for certain patients with brain metastases, according to a new study presented October 7, 2002, at the American Society for Therapeutic Radiology and Oncology's Annual Meeting in New Orleans.

Stereotactic radiosurgery is a well-tolerated, one-day outpatient procedure during which a high dose of radiation therapy is delivered to a tumor within the brain, while minimizing the dose to the surrounding normal brain. This study investigated whether this procedure is beneficial to patients with brain metastases, which is cancer that started in other parts of the body, such as the lung, breast or colon, and has spread to the brain.

Between 1996 and 2001, 333 patients were randomly assigned to receive either whole brain radiation therapy alone, or whole brain radiation therapy followed by stereotactic radiosurgery. The study was designed to detect improvement in the median survival time of patients and to track performance status for all patients.

Researchers found that there was a statistically significant improvement in survival with stereotactic radiosurgery for certain patients. These patients included those with solitary brain metastases, those who were in RPA class I, those under the age of 50 and patients with non-small cell lung cancer or any squamous cell carcinoma. Other groups approached statistical significance.

"At least as important, if not more important, was the finding that there was a statistically significant benefit in performance status, local control of the brain tumors and reduced steroid dependence in the radiosurgery group. Many patients and families consider these quality of life issues more important than the quantity of life. Based on these findings alone, whole brain radiation therapy followed by stereotactic radiosurgery should become the standard of care for patients with one to three brain metastases. The survival advantage is an added benefit," said Paul W. Sperduto, M.D., of Methodist Hospital in Minneapolis and lead author of the study. Dr. Sperduto also cautioned clinicians not to extrapolate these findings to patients with more than three metastases, for whom the benefit of this approach remains unknown.