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study shows radiosurgery preferable to wbr

Don M

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Kudos for the University of Pittsburgh School of Medicine study "Treating four or more brain tumors in a single radiosurgery session resulted in improved survival compared to whole brain radiation therapy alone," as reported at the 47th Annual Meeting of ASTRO.

In the study, patients with primary malignancies that had metastasized to the brain underwent Gamma-Knife radiosurgery and the results indicated that treating four or more brain tumors with radiosurgery is safe and effective and translates into a survival benefit for patients.

After five years of trying to hammer this information home, even M.D. Anderson Cancer Center, noted in their OncoLog, that although whole brain radiation "may" still be the standard for "four or more" brain tumors, there are a variety of effective treatment modalities for people who have fewer than four tumors, and in particular for a solitary brain metastasis.

The UCLA Metastatic Brain Tumor Program's goal is to treat metastatic disease "focally" so as to spare normal brain tissue and function. Focal treatment allows retreatment of local and new recurrences. This treatment delivers a single, large dose of radiation that is precisely targeted to the tumor and causes minimal damage to surrounding brain structures.

An editorial to Patchell, et al studies by Drs. Arlan Pinzer Mintz and J. Gregory Cairncross (JAMA 1998;280:1527-1529) described the morbidity associated with whole brain radiation and emphasized the importance of individualized treatment decisions and quality-of-life outcomes. Patients who avoided the neurologic side effects of whole brain radiation had an improvement in survival. His studies convincingly showed there was no survival benefit or prolonged independence in patients who received postoperative whole brain radiation therapy. There may have been some less tumor recurrence but not more long-term survival.


You may want to look at virtualtrials.com about a Chemosensitivity assay for malignant brain tumors (brain mets). Chemosensitivity testing might help you find the best option. It's an idea worth looking into.


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Long-Term Survival Possible After Radiosurgery for Brain Metastases

By Will Boggs, MD

NEW YORK (Reuters Health) Jan 12 - Many patients can survive for years after effective gamma knife radiosurgery for brain metastases, according to a report in the December 15, 2005 issue of Cancer.

Brain metastases complicate as many as 40% of systemic malignancies, the authors explain, and stereotactic radiosurgery of these metastases can extend survival to 13 months or beyond, depending on tumor type.

Dr. Douglas Kondziolka from the University of Pittsburgh Medical Center, Pennsylvania and colleagues assessed 44 patients who survived more than 4 years after radiosurgery to determine clinical and treatment patterns potentially responsible for their outcome.

The patients represented 6.5% of the patients with brain metastases who underwent radiosurgery between 1988 and 2000 at their institution. The median survival of these patients was 68 months, and 16 patients remained alive at the time of last follow-up, with a maximum survival of 156 months so far.

At the last follow-up, 99 of 133 (74.4%) brain metastases had regressed, 22 remained unchanged in volume (16.5%), and 12 (9%) had enlarged, the results indicate. Twenty-one of the patients required additional radiosurgery procedures, the researchers note, with one patient (who lived for more than 10 years) requiring seven radiosurgeries.

Compared with patients who died within the first 3 months after radiosurgery, this group showed no differences in age; gender; percentage of lung carcinoma, melanoma, or renal cell carcinoma; radiosurgery margin dose; use of prior whole brain radiation therapy; volume of the largest tumor; or total tumor volume.

Patients who lived more than 4 years had higher pre-radiosurgery Karnofsky performance scores, fewer metastases, and less extracranial disease burden than did patients who died in the early months after radiosurgery, the investigators observe.

"Despite our traditional methods to predict how patients with cancer will fare (cancer type, extent of cancer), some patients 'beat the odds' and do much better than anyone might have predicted," Dr. Kondziolka told Reuters Health.

"In order that we increase the number of such patients, we should continue to offer comprehensive cancer care, whenever appropriate, even in the appearance of negative findings (i.e., the appearance of brain metastases)," Dr. Kondziolka added. "When I discuss things with patients, I offer them hope that perhaps they will do much better than the textbooks might predict."

Cancer 2005;104:2784-2791.

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