June 8, 2006

More radiation doesn’t improve brain tumor outcome

NEW YORK (Reuters Health) - For patients with cancer that
has spread to the brain from other sites, adding whole-brain
radiation therapy to focused radiation does not seem to improve
survival, doctors in Japan report.

Skipping whole-brain radiation does lead to increased
recurrence of brain tumors. However, successful treatment is
still possible in the event of a relapse, and omission of
whole-brain radiation could avoid long-term neurological

"There is not yet a general consensus regarding the risks
and benefits of omitting up-front whole-brain radiation
therapy," Dr. Hidefumi Aoyama and colleagues note in their
article in the Journal of the American Medical Association.

Aoyama, from Hokkaido University Graduate School of
Medicine in Sapporo, and associates conducted a study in which
132 patients with one to four brain lesions were randomly
assigned to get only focused radiation -- called stereotactic
radiosurgery -- or stereotactic radiosurgery plus whole-brain

There was no significant difference between groups in
mortality over 2 years of follow-up or for deaths attributed to
neurological causes.

However, rates of recurrence over a 12-month period were
47% in the dual-treatment group and 76% in the single-therapy
group. More patients in the stereotactic radiosurgery group
underwent "salvage" treatment for progression of brain tumors.

As to how this study and other recent trials should be
interpreted, editorialist Dr. Jeffrey Raizer suggests that
patients with four or more brain lesions should be treated with
whole-brain radiation. For those with fewer than four, "either
mode is a reasonable first choice."

"Whether overall quality of life is positively or
negatively affected is unknown, but for patients who might be
cured of their cancer, omitting whole-brain radiation therapy
could avoid long-term neurotoxic effects," concludes Raizer, at
Northwestern University, Chicago.

SOURCE: Journal of the American Medical Association, June
7, 2006.