Stereotactic radiosurgery (SRS) outperforms whole-brain radiotherapy (WBRT) in patients who have undergone surgical resection for brain cancer, according to research presented at the American Society for Radiation Oncology (ASTRO) meeting in Boston.
In a four-year study, a team led by Dr. Paul Brown of the Mayo Clinic in Rochester, MN, found that SRS led to reduced cognitive decline, better quality of life, and statistically comparable survival rates in comparison with WBRT.
Patients undergo surgical resection of large brain metastases to confirm diagnosis, remove lesions, or reduce pressure in the brain, according to a statement from ASTRO. But there is a high incidence of tumor recurrence after surgery alone, and although postoperative WBRT reduces this recurrence, it can negatively affect a patient's cognitive function and quality of life.
Brown and colleagues conducted their trial from 2011 to 2015 and included 194 patients, each of whom had one to four brain metastases. Patients were randomized to receive SRS or WBRT after surgical resection of one lesion.
Median follow up was 15.6 months, and the researchers found no statistically significant difference in overall survival rates between treatment groups. However, the patients who had SRS experienced significantly longer survival without cognitive decline, while the negative cognitive impact of WBRT persisted: The rate of cognitive deterioration at six months was 85.7% after WBRT, compared with 53.8% after SRS.
At three months following treatment, declines in quality of life were significantly smaller after SRS than WBRT, with a mean quality of life change from baseline of -1.5 for SRS and -7.0 for WBRT. This result persisted through six months post-treatment, according to Brown's group.
"Our results confirm that radiosurgery to the surgical cavity is a viable treatment option to improve local control with less impact on cognitive function and quality of life compared to WBRT," Brown said in the ASTRO statement. "There is no significant difference in survival whether a patient receives postoperative radiosurgery or WBRT, and radiosurgery avoids the well-known toxicities of WBRT."
