Results from a randomized Phase III study indicate that whole-brain radiation therapy (WBRT) following removal of one to three brain metastases with surgery or radiosurgery does not improve overall survival or duration of functional independence but does reduce recurrence of brain metastases. These findings were recently published in the Journal of Clinical Oncology.
One common site for various types of cancer to spread is the brain. For decades, WBRT has been the standard treatment for patients with brain metastases. However, researchers have developed more precise delivery of radiation to the site(s) of cancer so that more radiation can be delivered to the cancer and healthy surrounding tissue may be spared from the side effects of radiation. Stereotactic radiosurgery (SRS) involves the precise three-dimensional delivery of radiation directly to the cancer. In recent years, SRS combined with WBRT has shown a survival benefit over WBRT alone. The risks and benefits of adding WBRT to either SRS or surgical removal of brain metastases are unclear; studies are ongoing.
In the current Phase III randomized study, researchers evaluated whether patients with brain metastases who had undergone either SRS or complete surgical resection of their brain metastases would benefit from the addition of WBRT. Specifically, researchers were interested in determining whether or not WBRT would improve the duration of cognitive function by improving the control of recurrent disease in the brain. Patients enrolled in this study had one to three brain metastases from any solid tumor except for small cell lung cancer and were considered to have a performance status of 0-2, which includes the following:
- Asymptomatic and fully able to carry on normal activities (performance status 0)
- Symptomatic and able to continue light activities, restricted from strenuous activities (performance status 1)
- Symptomatic and unable to work but out of bed more than half of the time (performance status 2)
Following removal of brain metastases by either SRS or surgery, 359 patients were randomized to receive WBRT or observation only and were monitored to determine how long it took for a patient’s performance status to deteriorate past status 2.
- For patients randomized to the observation arm, the median time to a performance status greater than 2 was 10.0 months.
- For patients randomized to the WBRT arm, the median time to a performance status greater than 2 was 9.5 months.
- Overall survival was similar in both arms of the study.
- WBRT reduced the recurrence rate of brain metastases from nearly 80% to approximately 50%.
- Death due to progression of brain metastases occurred in 44% of patients in the observation arm and 28% of patients in the WBRT arm.
The researchers concluded that WBRT following SRS or surgical removal of one to three brain metastases did not improve overall survival or duration of time before performance status deterioration; however, WBRT did impact death due to brain metastases as well as brain metastases recurrences.
 Kocher M, Soffietti R, Abacioglu U, et al. Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: Results of the EORTC 22952-26001 Study. Journal of Clinical Oncology [early online publication]. November 1, 2010.