Randomized Treatment of Brain Metastasis with Gamma Knife Radiosurgery, Whole Brain Radiotherapy or Both
Joel W. Goldwein, MD
Last Modified: October 23, 2000
Presenter: P. B. Chougule Affiliation Rhode Island Hospital/Brown University, Providence, RI
Brain metastases develop in approximately 25% of all cancer patients. Management with whole brain RT may palliated these patients, but survival remains dismal. This report is of a group of patients randomized to either whole brain RT (WBRT), Gamma Knife Therapy (GK) or both (WBRT+GK).
Patients were randomized to WBRT, GK or WBRT+GK, stratified by treatment site
Outcomes were compared for survival and local control
Patients were evenly distributed to the 3 arms; 34 for WBRT, 35 for GK+WBRT and 36 for GK
Median survival was between 5 - 7 months, and was not different for any group
Local control was 52% for the WBRT group, 82% for the WBRT+GK group, and 79% for the GK group (p = .0003)
The risk of developing a new brain lesion in un-irradiated brain was significantly higher (approx 40%) in patients who received GK therapy vs approx 20% in patients treated with WBRT or WBRT + GK
Surgically resected patients had a better outcome, seen primarily in patients who did not receive GK
GK therapy does not impact on survival
GK therapy results in improved local control
The risk of developing new brain lesions in patients who do not receive WBRT is higher than those who do
GK therapy in conjunction with whole brain RT may improve local control for some patients with brain matastases but probably does not impact survival.
Selection of patients who underwent surgical resection may have had an impact on the outcome of this study
Oct 4, 2013 - For patients with brain metastases, hippocampal avoidance whole brain radiotherapy is associated with less memory decline at four months, according to a study presented at the annual meeting of the American Society for Radiation Oncology, held from Sept. 22 to 25 in Atlanta.