Adult Brain Tumors Treatment (PDQ®): Treatment - Health Professional Information [NCI]-Treatment Option Overview

Adult Brain Tumors Treatment (PDQ®): Treatment - Health Professional Information [NCI] - Treatment Option Overview

Adult Brain Tumors Treatment (PDQ®): Treatment - Health Professional Information [NCI] Guide

• General Information About Adult Brain Tumors
• Classification of Adult Brain Tumors
• Treatment Option Overview
• Management of Specific Tumor Types and Locations
• Recurrent Adult Brain Tumors
• Changes to This Summary (02 / 28 / 2014)
• About This PDQ Summary
• Get More Information From NCI

A phase III randomized trial compared adjuvant WBRT with observation after surgery or radiosurgery for a limited number of brain metastases in patients with stable solid tumors.[48] Health-related quality of life was improved in the observation-only arm compared with WBRT. Patients in the observation arm had better mean scores in physical, role, and cognitive functioning at 9 months. In an exploratory analysis, statistically significant worse scores for bladder control, communication deficit, drowsiness, hair loss, motor dysfunction, leg weakness, appetite loss, constipation, nausea/vomiting, pain, and social functioning were observed in patients who underwent WBRT compared with those who underwent observation only.[48][Level of evidence: 1iiC]

The study that had a primary endpoint of learning and neurocognition, using a standardized test for total recall, was stopped by the data and safety monitoring committee because of worse outcomes in the WBRT group.[46]

Given this body of information, focal therapy plus WBRT or focal therapy alone, with close follow-up with serial MRIs and initiation of salvage therapy when clinically indicated, appear to be reasonable treatment options. The pros and cons of each approach should be discussed with the patient.[46][Level of evidence: 1iiD]

Treatment for patients with multiple metastases

Patients with multiple brain metastases may be treated with WBRT. Surgery is indicated to obtain tissue from a metastasis with an unknown primary tumor or to decompress a symptomatic dominant lesion that is causing significant mass effect. SRS in combination with WBRT has been assessed. A meta-analysis of two trials with a total of 358 participants found no statistically significant difference in OS between the WBRT plus SRS and WBRT alone groups (HR, 0.82; 95% CI, 0.65-1.02). Patients in the WBRT plus SRS group had decreased local failure compared with patients who received WBRT alone (HR, 0.27; 95% CI, 0.14-0.52). Unchanged or improved Karnofsky Performance Scale at 6 months was seen in 43% of patients in the combined therapy group versus only 28% in the WBRT group (P = .03).[49][Level of evidence: 1iiDiii]

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