Whole-Brain Radiotherapy After Resection of Metastases
This is the Medscape Neurology Minute. I'm Dr. Alan Jacobs.
Researchers from the University of Koln, Germany, have published a phase 3 trial assessing whether adjuvant whole-brain radiotherapy increases the duration of functional independence after surgery or radiosurgery of brain metastases. They included 359 patients with 1 to 3 metastases of solid tumors with stable systemic disease or asymptomatic primary tumors and WHO [World Health Organization] performance status of 0 to 2 who were treated with complete surgery or radiosurgery and randomly assigned to adjuvant whole-brain radiation or observation.
The primary endpoint was deterioration to WHO performance status of more than 2. The median time to the primary endpoint was 10 months after observation and 9.5 months after whole-brain radiation treatment. Overall survival was similar in the 2 arms. Whole-brain radiation treatment reduced the 2-year relapse rate both at initial sites and at new sites. Salvage therapies were used more frequently after observation than after whole-brain radiation therapy. Intracranial progression caused death in 44% of patients in the observation arm and in 28% (180 patients) in the whole-brain radiation arm.
After surgical treatment of a limited number of brain metastases, adjuvant whole-brain radiation reduces intracranial relapses and neurologic deaths but fails to improve the duration of functional independence and overall survival.
This article was selected from Medscape Best Evidence. I'm Dr. Alan Jacobs.
Abstract
This is the Medscape Neurology Minute. I'm Dr. Alan Jacobs.
Researchers from the University of Koln, Germany, have published a phase 3 trial assessing whether adjuvant whole-brain radiotherapy increases the duration of functional independence after surgery or radiosurgery of brain metastases. They included 359 patients with 1 to 3 metastases of solid tumors with stable systemic disease or asymptomatic primary tumors and WHO [World Health Organization] performance status of 0 to 2 who were treated with complete surgery or radiosurgery and randomly assigned to adjuvant whole-brain radiation or observation.
The primary endpoint was deterioration to WHO performance status of more than 2. The median time to the primary endpoint was 10 months after observation and 9.5 months after whole-brain radiation treatment. Overall survival was similar in the 2 arms. Whole-brain radiation treatment reduced the 2-year relapse rate both at initial sites and at new sites. Salvage therapies were used more frequently after observation than after whole-brain radiation therapy. Intracranial progression caused death in 44% of patients in the observation arm and in 28% (180 patients) in the whole-brain radiation arm.
After surgical treatment of a limited number of brain metastases, adjuvant whole-brain radiation reduces intracranial relapses and neurologic deaths but fails to improve the duration of functional independence and overall survival.
This article was selected from Medscape Best Evidence. I'm Dr. Alan Jacobs.
Abstract
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