Comparing Postoperative Radiation Therapies for Brain Metastases
Name of the Trial
Phase III Randomized Study of Post-Surgical Stereotactic Radiosurgery Versus Whole-Brain Radiotherapy in Patients with Resected Metastatic Brain Metastases (NCCTG-N107C). See the protocol summary.
Dr. Paul Brown, North Central Cancer Treatment Group
Why This Trial Is Important
Cancer that spreads from the site of an original, or primary, tumor to other parts of the body is called metastatic cancer. Although there are exceptions, metastatic cancer is usually incurable and often leads to death. Treatment for metastatic cancer is usually given in an attempt to delay further progression of the disease, prolong life, and/or alleviate symptoms.
Metastatic cancer may spread anywhere in the body, but the lungs, liver, bones, and brain are commonly affected. Metastatic tumors in the brain (brain metastases) are usually treated with radiation therapy alone, but occasionally these tumors can be removed (resected) with surgery. Surgical resection may improve survival, but, unfortunately, recurrence is common.
Therefore, whole-brain radiotherapy (WBRT) is usually used after surgery in an attempt to improve tumor control. Although the use of WBRT has been associated with improved tumor control, studies have not shown that it improves patient survival. In addition, WBRT can decrease long-term neurocognitive functioning, severely affecting a patient's quality of life.
Recently, doctors have begun using a different type of radiation therapy—stereotactic radiosurgery—following surgical resection of brain metastases. Stereotactic radiosurgery directs a large amount of radiation in one single treatment to the area where a tumor was resected, whereas WBRT delivers radiation to the entire brain in small doses, or fractions, over a period of several weeks.
In this clinical trial, patients with one to four brain metastases who have had at least one of the metastatic tumors removed surgically will be randomly assigned to undergo WBRT or stereotactic radiosurgery. Doctors will assess the effects of these treatments on overall survival and neurocognitive functioning. They will also monitor the patients for quality of life, functional independence, adverse events, and tumor recurrence.
"Brain metastasis is the most common cancer diagnosis in the brain and is several fold more frequent than the most common primary brain cancer," said Dr. Brown. "So brain metastases are a significant problem in oncology.
"Whole-brain radiotherapy has been the standard of care for brain metastases, but recently there's been a growing interest in radiosurgery to the surgical bed because you can irradiate just the surgical bed and potentially reduce the side effects," Dr. Brown explained. "The issue with radiosurgery to the surgical bed is there is very little literature supporting its use, and we don't know how effective it is compared to whole-brain radiotherapy. This trial, which is being conducted in collaboration with other NCI cooperative groups, will provide that head-to-head comparison to the standard of care, whole-brain radiotherapy."