Artikel
Sector irradiation vs. whole-brain irradiation after resection of singular brain metastasis – interim analysis of a prospective randomized monocentric trial
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Veröffentlicht: | 8. Juni 2016 |
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Objective: Microsurgical resection of cerebral metastases leads to prolonged survival and rapid relief of symptoms in selected patients. To minimize the risk of local recurrence whole-brain irradiation (WBRT) has been established as standard adjuvant treatment in these patients. With the advances in systemic cancer treatment and prolonged overall survival, however, deleterious effects of WBRT are becoming more relevant. Sector irradiation aims to spare brain tissue by focusing the irradiation in the area of the tumor bed. The aim of this study is to investigate whether adjuvant “sector” irradiation following microsurgical resection is equivalent to adjuvant WBRT in terms of local control and potentially superior in terms of quality of life and neurocognitive deficits in a prospective randomized trial.
Method: The study is a monocentric, randomized trial in patients with a singular brain metastasis. Efficacy was evaluated by clinical and radiological visits every 3 months. Primary endpoints were overall survival (OS) and local recurrence, secondary endpoints were distant intracranial progression and time to clinical deterioration.
Results: At the time of analysis 28 patients were enrolled in this trial, there were 3 drop-outs. 12 Patients were assigned to standard WBRT and 13 patients were randomized to sector irradiation. Treatment started within 30 days after resection in both groups (29,7 days in sector group and 30 days in WBRT group, n.s.). There was no local recurrence in the sector group, whereas one patient recurred within 3 months after WBRT locally. A distant progression was noted in 3 patients after WBRT within 9 (3-20) months and 4 patients after sector irradiation developed distant metastases after a mean of 5 (1-9) months. The OS was slightly higher in the sector group with 12,2 months (10 of 13 patients still alive) compared to 11,2 months (7 of 12 patients still alive, n.s.). We found no significant differences in terms of OS and local control while we show the sector irradiation to be a reliable, brain sparing method in the treatment of singular brain metastasis.
Conclusions: Sector irradiation as a brain tissue sparing method achieves local control comparable to WBRT after resection of a singular brain metastasis. Our preliminary results thus indicate equivalent efficacy of sector irradiation. With the unexpectedly long average survival (17 of 25 patients alive after an average of 11,66 months), however, long-term follow-up is mandatory to determine any impact of overall survival.