Effect of Postoperative Radiotherapy for Brain Metastases: An Analysis

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Abstract

Introduction: Brain metastases (BM) have a very poor prognosis, creating a demand for effective local therapies, such as radiotherapy (RT) and neurosurgery, the combination of which is debatable. The aim of the present study was to investigate prognostic factors and to develop treatment recommendations for patients with BM. Material and Methods: A total of 84 patients treated between May 2011 and July 2016 were analyzed in a single-institution retrospective study. Results: Overall survival (OS) was 10.3 months. Poor OS was defined by a Karnofsky performance index of ≤70% (2.9 vs. 15.8 months; p = 0.009), male gender (6.5 vs. 18.3 months; p = 0.044), and incomplete neurosurgical resection (2.5 vs. 15.8 months; p = 0.017). These factors were also shown to be significant in univariate analysis, while only radical resection remained significant in multivariate testing ( p = 0.023). A direct comparison between whole-brain RT (with or without boost) and local RT illustrated a superior OS for local therapy (22.7 vs. 9.5 months; p = 0.022), especially in case of up to 3 metastases ( p = 0.041). Intracranial control was 81% with a median duration of 31.6 months. Conclusion: Combined modality treatment of RT and neurosurgery is effective and feasible. A complete removal of all metastases is the cardinal prognostic factor.

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Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC·3): a multicentre, randomised, controlled, phase 3 trial.

Paul D. Brown, Karla V. Ballman, Jane H Cerhan … (2017)

Whole brain radiotherapy (WBRT) is the standard of care to improve intracranial control following resection of brain metastasis. However, stereotactic radiosurgery (SRS) to the surgical cavity is widely used in an attempt to reduce cognitive toxicity, despite the absence of high-level comparative data substantiating efficacy in the postoperative setting. We aimed to establish the effect of SRS on survival and cognitive outcomes compared with WBRT in patients with resected brain metastasis.

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Preservation of memory with conformal avoidance of the hippocampal neural stem-cell compartment during whole-brain radiotherapy for brain metastases (RTOG 0933): a phase II multi-institutional trial.

Vinai Gondi, Stephanie L Pugh, Wolfgang Tome … (2014)

Hippocampal neural stem-cell injury during whole-brain radiotherapy (WBRT) may play a role in memory decline. Intensity-modulated radiotherapy can be used to avoid conformally the hippocampal neural stem-cell compartment during WBRT (HA-WBRT). RTOG 0933 was a single-arm phase II study of HA-WBRT for brain metastases with prespecified comparison with a historical control of patients treated with WBRT without hippocampal avoidance. Eligible adult patients with brain metastases received HA-WBRT to 30 Gy in 10 fractions. Standardized cognitive function and quality-of-life (QOL) assessments were performed at baseline and 2, 4, and 6 months. The primary end point was the Hopkins Verbal Learning Test-Revised Delayed Recall (HVLT-R DR) at 4 months. The historical control demonstrated a 30% mean relative decline in HVLT-R DR from baseline to 4 months. To detect a mean relative decline ≤ 15% in HVLT-R DR after HA-WBRT, 51 analyzable patients were required to ensure 80% statistical power with α = 0.05. Of 113 patients accrued from March 2011 through November 2012, 42 patients were analyzable at 4 months. Mean relative decline in HVLT-R DR from baseline to 4 months was 7.0% (95% CI, -4.7% to 18.7%), significantly lower in comparison with the historical control (P < .001). No decline in QOL scores was observed. Two grade 3 toxicities and no grade 4 to 5 toxicities were reported. Median survival was 6.8 months. Conformal avoidance of the hippocampus during WBRT is associated with preservation of memory and QOL as compared with historical series. © 2014 by American Society of Clinical Oncology.

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Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial.

R Patchell, P Tibbs, W F Regine … (1998)

For the treatment of a single metastasis to the brain, surgical resection combined with postoperative radiotherapy is more effective than treatment with radiotherapy alone. However, the efficacy of postoperative radiotherapy after complete surgical resection has not been established. To determine if postoperative radiotherapy resulted in improved neurologic control of disease and increased survival. Multicenter, randomized, parallel group trial. University-affiliated cancer treatment facilities. Ninety-five patients who had single metastases to the brain that were treated with complete surgical resections (as verified by postoperative magnetic resonance imaging) between September 1989 and November 1997 were entered into the study. Patients were randomly assigned to treatment with postoperative whole-brain radiotherapy (radiotherapy group, 49 patients) or no further treatment (observation group, 46 patients) for the brain metastasis, with median follow-up of 48 weeks and 43 weeks, respectively. The primary end point was recurrence of tumor in the brain; secondary end points were length of survival, cause of death, and preservation of ability to function independently. Recurrence of tumor anywhere in the brain was less frequent in the radiotherapy group than in the observation group (9 [18%] of 49 vs 32 [70%] of 46; P<.001). Postoperative radiotherapy prevented brain recurrence at the site of the original metastasis (5 [10%] of 49 vs 21 [46%] of 46; P<.001) and at other sites in the brain (7 [14%] of 49 vs 17 [37%] of 46; P<.01). Patients in the radiotherapy group were less likely to die of neurologic causes than patients in the observation group (6 [14%] of 43 who died vs 17 [44%] of 39; P=.003). There was no significant difference between the 2 groups in overall length of survival or the length of time that patients remained functionally independent. Patients with cancer and single metastases to the brain who receive treatment with surgical resection and postoperative radiotherapy have fewer recurrences of cancer in the brain and are less likely to die of neurologic causes than similar patients treated with surgical resection alone.

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Author and article information

Journal

Journal ID (publisher-id): ORT

Journal ID (nlm-ta): Oncol Res Treat

Journal ID (doi): 10.1159/issn.2296-5270

Title: Oncology Research and Treatment

Publisher: S. Karger AG

ISSN (Print): 2296-5270

ISSN (Electronic): 2296-5262

Publication date Subscription-year: 2019

Publication date (Print): May 2019

Publication date (Electronic): 17 April 2019

Volume: 42

Issue: 5

Pages: 256-262

Affiliations

[_a] _aDepartment of Radiation Oncology, University Hospital Münster, Münster, Germany

[_b] _bDepartment of Neurosurgery, University Hospital Münster, Münster, Germany

Author notes

*Michael Oertel, MD, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, DE–48149 Münster (Germany), E-Mail michael.oertel@ukmuenster.de

Article

Publisher ID: 499323 Other ID: Oncol Res Treat 2019;42:256–261

DOI: 10.1159/000499323

PubMed ID: 30995671

SO-VID: 1924a7e3-1994-4189-adeb-1888da79d9b8

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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

History

Date received : 26 August 2018

Date accepted : 27 February 2019

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Figures: 3, Tables: 2, Pages: 7

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Effect of Postoperative Radiotherapy for Brain Metastases: An Analysis

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Abstract

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Karger: Oncology

Most cited references 23

Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC·3): a multicentre, randomised, controlled, phase 3 trial.

Preservation of memory with conformal avoidance of the hippocampal neural stem-cell compartment during whole-brain radiotherapy for brain metastases (RTOG 0933): a phase II multi-institutional trial.

Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial.

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