User login
Stereotactic Radiation Linked to Better Brain Mets Outcomes
TOPLINE:
In patients with 5-20 brain metastases, stereotactic radiation improved symptoms and reduced interference with daily functioning compared to hippocampal-avoidance whole brain radiation. The weighted composite MD Anderson Symptom Inventory-Brain Tumor score changed from 2.69 to 2.37 with stereotactic radiation compared with 2.29 to 3.03 with hippocampal-avoidance whole brain radiation.
METHODOLOGY:
- Randomized trials have shown stereotactic radiation preserves neurocognitive function and patient-reported outcomes compared with whole brain radiation in patients with four or less brain metastases. For patients with more than four brain metastases, published randomized comparisons of stereotactic radiation vs whole brain radiation were lacking prior to this study.
- Researchers conducted a phase 3, open-label, randomized clinical trial at four US-based centers, enrolling 196 patients between April 2017 and May 2024, with final follow-up in March 2025.
- Participants included patients with 5-20 brain metastases and no prior brain-directed radiation, with a median of 14 brain metastases per patient and 25% having undergone prior neurosurgical resection.
- The primary outcome was the mean weighted patient-reported symptom severity and interference score change over 6 months. The researchers used the MD Anderson Symptom Inventory-Brain Tumor instrument, with scores ranging from 0-10 and change range of -10 to 10, to measure outcomes.
- Stereotactic radiation was delivered in either 1 day (20 Gy) or five daily fractions (30 Gy, or 25 Gy for surgically removed tumors), while hippocampal-avoidance whole brain radiation was administered as 30 Gy in 10 daily fractions with memantine.
TAKEAWAY:
- Primary outcome analysis showed that stereotactic radiation was linked to a change in the weighted composite MD Anderson Symptom Inventory-Brain Tumor score of 2.69 to 2.37 (mean change, -0.32) compared with 2.29 to 3.03 (mean change, 0.74) with hippocampal-avoidance whole brain radiation (mean difference, -1.06; 95% CI, -1.54 to -0.58; P < .001).
- Functional independence via the Barthel Index was better in the stereotactic radiation group at 4 months (mean difference, 6.79; 95% CI, 1.19-12.38; P = .02) and 12 months (mean difference, 7.92; 95% CI, 1.34-14.49; P = .02).
- New brain metastases were more frequent with stereotactic radiation (1-year cumulative incidence, 45.4% vs 24.2%; P = .003), while local recurrence was lower (3.2% vs 39.5%; P < .001).
- Grade 3-5 adverse events occurred in 12% of stereotactic radiation patients vs 13% in the hippocampal-avoidance whole brain radiation group, with fatigue being most common (28% vs 44%).
IN PRACTICE:
“While [the trial] clearly demonstrates that patients with 5-20 brain metastases have improved symptom burden and lowered interference with daily functioning, there are questions that remain for stereotactic radiosurgery in this population. Patients receiving stereotactic radiosurgery for brain metastases have a higher need for future salvage procedures, and this rate of salvage procedures is higher for patients with an increased number of brain metastases at diagnosis… Moreover, it has been shown that the upfront decision between stereotactic radiosurgery and whole brain radiotherapy is the single decision that contributes most to the cost of care of a patient with brain metastases,” said Michael Chan, MD, in an accompanying editorial published in JAMA.
SOURCE:
The study was led by Ayal A. Aizer, MD, MHS, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston. It was published online on February 19 in JAMA.
LIMITATIONS:
According to the authors, the study was not blinded, and the primary outcome was subjective. High mortality limited long-term data collection, reducing precision and biasing outcomes toward survivors. Additionally, randomization was not stratified by treating center, allowing possible unmeasured imbalances. The minimal clinically important difference had not been defined for many study outcome measures.
DISCLOSURES:
The trial was supported by Varian, a Siemens Healthineers Company. Aizer disclosed receiving grants from NH TherAguix Research outside the submitted work. Additional disclosures are noted in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article first appeared on Medscape.com.
TOPLINE:
In patients with 5-20 brain metastases, stereotactic radiation improved symptoms and reduced interference with daily functioning compared to hippocampal-avoidance whole brain radiation. The weighted composite MD Anderson Symptom Inventory-Brain Tumor score changed from 2.69 to 2.37 with stereotactic radiation compared with 2.29 to 3.03 with hippocampal-avoidance whole brain radiation.
METHODOLOGY:
- Randomized trials have shown stereotactic radiation preserves neurocognitive function and patient-reported outcomes compared with whole brain radiation in patients with four or less brain metastases. For patients with more than four brain metastases, published randomized comparisons of stereotactic radiation vs whole brain radiation were lacking prior to this study.
- Researchers conducted a phase 3, open-label, randomized clinical trial at four US-based centers, enrolling 196 patients between April 2017 and May 2024, with final follow-up in March 2025.
- Participants included patients with 5-20 brain metastases and no prior brain-directed radiation, with a median of 14 brain metastases per patient and 25% having undergone prior neurosurgical resection.
- The primary outcome was the mean weighted patient-reported symptom severity and interference score change over 6 months. The researchers used the MD Anderson Symptom Inventory-Brain Tumor instrument, with scores ranging from 0-10 and change range of -10 to 10, to measure outcomes.
- Stereotactic radiation was delivered in either 1 day (20 Gy) or five daily fractions (30 Gy, or 25 Gy for surgically removed tumors), while hippocampal-avoidance whole brain radiation was administered as 30 Gy in 10 daily fractions with memantine.
TAKEAWAY:
- Primary outcome analysis showed that stereotactic radiation was linked to a change in the weighted composite MD Anderson Symptom Inventory-Brain Tumor score of 2.69 to 2.37 (mean change, -0.32) compared with 2.29 to 3.03 (mean change, 0.74) with hippocampal-avoidance whole brain radiation (mean difference, -1.06; 95% CI, -1.54 to -0.58; P < .001).
- Functional independence via the Barthel Index was better in the stereotactic radiation group at 4 months (mean difference, 6.79; 95% CI, 1.19-12.38; P = .02) and 12 months (mean difference, 7.92; 95% CI, 1.34-14.49; P = .02).
- New brain metastases were more frequent with stereotactic radiation (1-year cumulative incidence, 45.4% vs 24.2%; P = .003), while local recurrence was lower (3.2% vs 39.5%; P < .001).
- Grade 3-5 adverse events occurred in 12% of stereotactic radiation patients vs 13% in the hippocampal-avoidance whole brain radiation group, with fatigue being most common (28% vs 44%).
IN PRACTICE:
“While [the trial] clearly demonstrates that patients with 5-20 brain metastases have improved symptom burden and lowered interference with daily functioning, there are questions that remain for stereotactic radiosurgery in this population. Patients receiving stereotactic radiosurgery for brain metastases have a higher need for future salvage procedures, and this rate of salvage procedures is higher for patients with an increased number of brain metastases at diagnosis… Moreover, it has been shown that the upfront decision between stereotactic radiosurgery and whole brain radiotherapy is the single decision that contributes most to the cost of care of a patient with brain metastases,” said Michael Chan, MD, in an accompanying editorial published in JAMA.
SOURCE:
The study was led by Ayal A. Aizer, MD, MHS, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston. It was published online on February 19 in JAMA.
LIMITATIONS:
According to the authors, the study was not blinded, and the primary outcome was subjective. High mortality limited long-term data collection, reducing precision and biasing outcomes toward survivors. Additionally, randomization was not stratified by treating center, allowing possible unmeasured imbalances. The minimal clinically important difference had not been defined for many study outcome measures.
DISCLOSURES:
The trial was supported by Varian, a Siemens Healthineers Company. Aizer disclosed receiving grants from NH TherAguix Research outside the submitted work. Additional disclosures are noted in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article first appeared on Medscape.com.
TOPLINE:
In patients with 5-20 brain metastases, stereotactic radiation improved symptoms and reduced interference with daily functioning compared to hippocampal-avoidance whole brain radiation. The weighted composite MD Anderson Symptom Inventory-Brain Tumor score changed from 2.69 to 2.37 with stereotactic radiation compared with 2.29 to 3.03 with hippocampal-avoidance whole brain radiation.
METHODOLOGY:
- Randomized trials have shown stereotactic radiation preserves neurocognitive function and patient-reported outcomes compared with whole brain radiation in patients with four or less brain metastases. For patients with more than four brain metastases, published randomized comparisons of stereotactic radiation vs whole brain radiation were lacking prior to this study.
- Researchers conducted a phase 3, open-label, randomized clinical trial at four US-based centers, enrolling 196 patients between April 2017 and May 2024, with final follow-up in March 2025.
- Participants included patients with 5-20 brain metastases and no prior brain-directed radiation, with a median of 14 brain metastases per patient and 25% having undergone prior neurosurgical resection.
- The primary outcome was the mean weighted patient-reported symptom severity and interference score change over 6 months. The researchers used the MD Anderson Symptom Inventory-Brain Tumor instrument, with scores ranging from 0-10 and change range of -10 to 10, to measure outcomes.
- Stereotactic radiation was delivered in either 1 day (20 Gy) or five daily fractions (30 Gy, or 25 Gy for surgically removed tumors), while hippocampal-avoidance whole brain radiation was administered as 30 Gy in 10 daily fractions with memantine.
TAKEAWAY:
- Primary outcome analysis showed that stereotactic radiation was linked to a change in the weighted composite MD Anderson Symptom Inventory-Brain Tumor score of 2.69 to 2.37 (mean change, -0.32) compared with 2.29 to 3.03 (mean change, 0.74) with hippocampal-avoidance whole brain radiation (mean difference, -1.06; 95% CI, -1.54 to -0.58; P < .001).
- Functional independence via the Barthel Index was better in the stereotactic radiation group at 4 months (mean difference, 6.79; 95% CI, 1.19-12.38; P = .02) and 12 months (mean difference, 7.92; 95% CI, 1.34-14.49; P = .02).
- New brain metastases were more frequent with stereotactic radiation (1-year cumulative incidence, 45.4% vs 24.2%; P = .003), while local recurrence was lower (3.2% vs 39.5%; P < .001).
- Grade 3-5 adverse events occurred in 12% of stereotactic radiation patients vs 13% in the hippocampal-avoidance whole brain radiation group, with fatigue being most common (28% vs 44%).
IN PRACTICE:
“While [the trial] clearly demonstrates that patients with 5-20 brain metastases have improved symptom burden and lowered interference with daily functioning, there are questions that remain for stereotactic radiosurgery in this population. Patients receiving stereotactic radiosurgery for brain metastases have a higher need for future salvage procedures, and this rate of salvage procedures is higher for patients with an increased number of brain metastases at diagnosis… Moreover, it has been shown that the upfront decision between stereotactic radiosurgery and whole brain radiotherapy is the single decision that contributes most to the cost of care of a patient with brain metastases,” said Michael Chan, MD, in an accompanying editorial published in JAMA.
SOURCE:
The study was led by Ayal A. Aizer, MD, MHS, Brigham and Women’s Hospital/Dana-Farber Cancer Institute, Boston. It was published online on February 19 in JAMA.
LIMITATIONS:
According to the authors, the study was not blinded, and the primary outcome was subjective. High mortality limited long-term data collection, reducing precision and biasing outcomes toward survivors. Additionally, randomization was not stratified by treating center, allowing possible unmeasured imbalances. The minimal clinically important difference had not been defined for many study outcome measures.
DISCLOSURES:
The trial was supported by Varian, a Siemens Healthineers Company. Aizer disclosed receiving grants from NH TherAguix Research outside the submitted work. Additional disclosures are noted in the original article.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
A version of this article first appeared on Medscape.com.
Stereotactic Radiation Linked to Better Brain Mets Outcomes
Stereotactic Radiation Linked to Better Brain Mets Outcomes