Randomized treatment of brain metastasis with gamma knife radiosurgery, whole brain radiotherapy or both
Presenter: P.B. Chougule
Affiliation: Rhode Island Hospital, Brown University
Whole brain radiation therapy (WBRT) has been the standard care for the majority of patients with brain metastasis. However, the outcome of these patients has been dismal due to both local and systemic failure. Stereotactic radiosurgery using either linac or Gamma Knife (GK) has been investigated in an attempt to improve patient’s outcome. In this study, the researchers reported a three-arm prospective randomized clinical trial comparing GK alone, WBRT alone or both in terms of local control or brain disease and overall survival.
- A total of 96 eligible patients were randomized to GK alone (36 patients), GK + WBRT (37 patients), and WBRT alone (31 Patients)
- All patients had three or less brain metastases and tumor volume of 30 ccs or less
- The treatment dose was: GK 30 Gy, WBRT 30 Gy in 10 fractions + GK 20 Gy, and WBRT 30 Gy in 10 fractions
- There was no difference in overall survival.
- Local control was 87%, 91%, and 62% for GK, GK + WBRT and WBRT alone arms, respectively, favored tow radiosurgery arms.
- The occurrence of new brain lesions was lower in the two arms receiving WBRT.
In this study, radiosurgery improved local control of metastases in the brain. However, better local control did not translate into survival advantage in patients with 3 or less brain metastases. It would be very interesting to revisit this strategy in the selected group of patients who have brain metastases but with control of their systemic disease.