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  • Oct 20, 2019
    For 1-3 melanoma brain metastases treated locally, whole brain radiotherapy is of no benefit

    Surgery and SRS are highly effective local treatments for brain metastases, including in patients with metastatic melanoma. However, they are at high risk of local recurrence after treatment. This trial aimed to evaluate the efficacy of adjuvant whole-brain radiotherapy in this patient population.

    The authors conducted a phase III trial in which patients with melanoma and 1-3 brain metastases who received SRS or surgery were randomized to receive whole brain radiotherapy (WBRT) or observation. The trial was conducted at 24 centers in Australia and Europe. 215 patients were enrolled between April 2009 and September 2017. The minimum dose for WBRT was 30 Gy.

    The primary end point was distant intracranial failure within 12 months. Secondary endpoints included time to intracranial failure, survival, and time to deterioration in performance status.

    Median follow-up was 48.1 months. 42% of patients in the WBRT and 50.5% in the observation groups developed distant intracranial failure (p=0.22). Over the entire follow-up period, 52% of patients in the WBRT and 57% in the observation group developed intracranial failure (p=0.39). Local failure rates were improved after WBRT – 20% in the WBRT arm and 33.6% in the observation arm (p=0.03). 12-month overall survival was equivalent, 41.5% in the WBRT and 51.4% in the observation arms (p=0.28). Median time to deterioration in performance status was 3.8 months vs 4.4 months (p=0.32) in the WBRT and observation arms, respectively. WBRT was associated with more grade 1 or 2 acute toxicity. 

    In sum, in patients with metastatic melanoma with 1-3 brain metastases who received surgery for SRS, adjuvant WBRT improved local control, but did not improve distant intracranial failure, overall survival, or preservation of performance status.

    Reference (PubMed Link): Hong AM, Fogarty GB, Dolven-Jacobsen K, et al. Adjuvant whole-brain radiation therapy compared with observation after local treatment of melanoma brain metastases: A multicenter, randomized phase iii trial. J Clin Oncol 2019;37:3132-3141.

    Key Institution: Multi-Institutional (Europe & Australia)
    Keywords: Melanoma metastases, Whole-brain Radiotherapy, Resection, Radiosurgery

  • Sep 20, 2019
    Survival not significantly different for patients with 2-4 vs 5-15 brain mets treated with SRS

    This study aims to evaluate whether SRS is an effective treatment approach for patient with 5-15 brain mets. This retrospective review 2083 patients who underwent Gamma Knife SRS as the initial treatment modality for intracranial metastases at 8 academic institutions between 1991 and 2013.

    Compared with the 2 to 4 BM group, 5 to 15 BM was not associated with an increased hazard of death.

    Predictors of Distant Brain Failure on multivariable analyses included age 65 years or greater, other histology, margin dose, 1 versus 2 to 4 BM and 5 to 15 versus 2 to 4 BM.

    Several clinical outcomes differed between the 2 to 4 and 5 to 15 BM groups, such as cumulative incidence of Distant Brain Failure and Brain Metastasis Velocity, both of which were higher in patients with 5 to 15 BM. However, these differences did not translate into more patients with 5 to 15 BM requiring salvage therapy.

    Bottom line: The present study confirms, in a North American population, findings from the Japanese multi-institutional study that patients with 2 to 4 BM do not have a significantly worse survival than patients with 5 or greater.  

    The number of BM probably should not be used alone to determine the choice of initial SRS versus WBRT in the management of BM.

    Prospective trials are needed to validate this finding.

    Reference (PubMed Link): Hughes RT, Masters AH, McTyre ER, et al. Initial srs for patients with 5 to 15 brain metastases: Results of a multi-institutional experience. Int J Radiat Oncol Biol Phys 2019;104:1091-1098.

    Key Institution: Multi-Institutional (Wake Forest School of Medicine)
    Keywords: SRS, Brain Metastasis 

  • Jul 30, 2018
    Stereotactic radiotherapy results in less neuropsychological and neuroendocrine impairment in young patients treated for brain tumors compared to conventional radiotherapy

    Long term outcomes and side effects from radiation therapy in young patients is of utmost importance. This study looked at neuropsychological and neuroendocrine outcomes pre- and post- radiation therapy for benign or low-grade CNS tumors.  The study from Tata Memorial Centre in Mumbai showed that stereotactic RT achieved superior outcomes compared to conventional RT without compromising survival.  This is an important step towards quality of life improvement for young RT patients.

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    Journal & Date: JAMA Oncology. 2017 Oct 1;3(10):1368-1376.
    Key Institution: Tata Memorial Centre, Mumbai, India
    Keywords: Stereotactic, Radiotherapy, Brain Tumors, Toxicity, Quality of Life, Clinical Trial

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