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Stereotactic radiosurgery improves survival for younger brain metastases patients

Mar 4, 2015

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Analysis led by Dr. Arjun Sahgal at Sunnybrook

Single dose, high precision radiation therapy improved survival by 65% for younger patients with brain cancer with limited spread compared to those who received single dose therapy followed by radiotherapy to the whole brain, reports a Sunnybrook-led analysis of research as published in the International Journal of Radiation Oncology, Biology, Physics (Red Journal).

Single dose, high precision radiation therapy, or stereotactic radiosurgery is a newer radiation therapy that delivers the dose with high precision, to a brain metastasis. The goal is to maximize local tumour control while sparing the patient’s normal brain tissue. Stereotactic radiosurgery is a specialized technique that is being delivered in comprehensive cancer centres with radiation oncology and neurosurgery teams working together.

The analysis comprised 364 patients with limited, small, metastases who participated in 3 randomized clinical trials evaluating stereotactic radiosurgery alone to stereotactic radiosurgery then whole brain radiotherapy conducted up to 2009. The researchers evaluated factors such as survival and distant brain control after treatment.

“This report increases our understanding of the treatment effects of additional whole brain radiotherapy on survival. Our hope is that the data will further inform patients and physicians on making decisions about individualized treatment to improve not only survival but quality of life and to save cognition,” says Dr. Arjun Sahgal, lead author, Site Lead, Central Nervous System Cancer Care Team, Sunnybrook Odette Cancer Centre and Associate Professor of Radiation Oncology and Surgery in the Department of Radiation Oncology at the University of Toronto.

The researchers report that for patients under 50 years of age who were treated with stereotactic radiosurgery alone, the median survival improved by 65% at 13.6 months, compared to the median survival of 8.2 months for patients of the same age who had stereotactic radiosurgery plus whole brain radiation treatment. Younger patients treated only with stereotactic radiosurgery also had no increased risk of developing new brain metastases (known as distant brain failure). The study concluded that stereotactic radiosurgery alone may be the preferred treatment option especially for this patient age group, and whole brain radiation reserved for later as one of many options should further brain metastases develop.

Arjun Sahgal

Full media release

THERAPY IMPROVES SURVIVAL FOR YOUNGER BRAIN METASTASES PATIENTS:

Analysis of Stereotactic Radiosurgery (single dose radiation therapy) shows survival advantage over traditional whole brain radiotherapy.

Toronto, CANADA (Wednesday March 4, 2015) – Single dose, high precision radiation therapy improved survival by 65% for younger patients with brain cancer with limited spread compared to those who received single dose therapy followed by radiotherapy to the whole brain, reports a Sunnybrook-led analysis of research as published in the International Journal of Radiation Oncology, Biology, Physics (Red Journal).

Single dose, high precision radiation therapy, or stereotactic radiosurgery is a newer radiation therapy thatdelivers the dose with high precision, to a brain metastasis. The goal is to maximize local tumour control while sparing the patient’s normal brain tissue. Stereotactic radiosurgery is a specialized technique that is being delivered in comprehensive cancer centres with radiation oncology and neurosurgery teams working together.

The analysis comprised 364 patients with limited, small, metastases who participated in 3 randomized clinical trials evaluating stereotactic radiosurgery alone to stereotactic radiosurgery then whole brain radiotherapy conducted up to 2009. The researchers evaluated factors such as survival and distant brain control after treatment.

“This report increases our understanding of the treatment effects of additional whole brain radiotherapy on survival. Our hope is that the data will further inform patients and physicians on making decisions about individualized treatment to improve not only survival but quality of life and to save cognition,” says Dr. Arjun Sahgal, lead author, Site Lead, Central Nervous System Cancer Care Team, Sunnybrook Odette Cancer Centre and Associate Professor of Radiation Oncology and Surgery in the Department of Radiation Oncology at the University of Toronto.

The researchers report that for patients under 50 years of age who were treated with stereotactic radiosurgery alone, the median survival improved by 65% at 13.6 months, compared to the median survival of 8.2 months for patients of the same age who had stereotactic radiosurgery plus whole brain radiation treatment. Younger patients treated only with stereotactic radiosurgery also had no increased risk of developing new brain metastases (known as distant brain failure). The study concluded that stereotactic radiosurgery alone may be the preferred treatment option especially for this patient age group, and whole brain radiation reserved for later as one of many options should further brain metastases develop.

Of the 364 patients who met eligibility criteria for this analysis, 186 or 51% were treated with stereotactic radiosurgery alone, and 178 or 49% were treated with stereotactic radiosurgery followed by whole brain radiation therapy.

Traditionally, stereotactic radiosurgery has been given to treat patients with brain metastases that are resistant to whole brain radiotherapy, or given as an added boost with whole brain radiotherapy. This study challenges the current standard of whole brain radiotherapy and these results point to stereotactic radiosurgery emerging as the future standard of care to treat patients with limited brain metastases with this technique alone. The specific aims are to minimize side effects of memory damage, maintain quality of life with the potential to improve survival.

According to the Canadian Cancer Society, an estimated 3,950 Canadians will be diagnosed this year with brain cancer or a cancer of the Central Nervous System.

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