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Whole Brain Radiotherapy Versus Stereotactic Radiosurgery in Poor-Prognosis Patients with One to 10 Brain Metastases:
1Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiation Oncology, BC Cancer Agency Vancouver Centre, Vancouver, British Columbia, Canada.
Clinical Oncology (Royal College of Radiologists (Great Britain))
|February 23, 2020
Summary
This feasibility study found that a randomized trial comparing whole brain radiotherapy (WBRT) to stereotactic radiosurgery (SRS) for brain metastases is achievable. Challenges in patient accrual and prognostication were noted, paving the way for a larger trial.
Area of Science:
- Oncology
- Radiation Oncology
- Clinical Trials
Background:
- Patients with brain metastases often have a poor prognosis, with limited survival.
- Optimal radiotherapy strategies for this patient group require further investigation.
Purpose of the Study:
- To assess the feasibility of a randomized trial comparing whole brain radiotherapy (WBRT) and stereotactic radiosurgery (SRS).
- To evaluate WBRT versus SRS as a radiotherapeutic strategy for patients with brain metastases and a poor prognosis.
Main Methods:
- A randomized feasibility study involving patients with 1-10 brain metastases (≤4 cm diameter) and a 3-6 month life expectancy.
- Patients were randomized to receive either WBRT (20 Gy/5 fractions) or SRS (15 Gy/1 fraction).
- Primary endpoint was the accrual rate per month; secondary endpoints included feasibility and clinical outcomes.
Main Results:
- 22 patients were enrolled out of 210 screened, with an accrual rate of 0.63 patients/month.
- Median survival was 7.0 months. Median intracranial progression-free survival was 1.8 months for SRS and 9.2 months for WBRT.
- Grade 3+ toxicities were 5 in the SRS arm and 1 in the WBRT arm; retreatment rates were 40% in both arms.
Conclusions:
- A randomized trial of WBRT versus SRS for brain metastases in patients with poor prognosis is feasible.
- Slower-than-expected accrual and prognostication difficulties were identified.
- A larger Phase III trial is planned to determine the optimal treatment strategy.
