A European Organisation for Research and Treatment of Cancer Phase III Trial of Adjuvant Whole-Brain Radiotherapy Versus Observation in Patients With One to Three Brain Metastases From Solid Tumors After Surgical Resection or Radiosurgery: Quality-of-Life Results

Abstract

This study shows that adjuvant WBRT after surgery or radiosurgery of a limited number of brain metastases from solid tumors may negatively impact some aspects of HRQOL, even if these effects are transitory. Consequently, observation with close monitoring with magnetic resonance imaging (as done in the EORTC trial) is not detrimental for HRQOL.

Comparative Survival in Patients with Brain Metastases from Non-small-Cell Lung Cancer Treated before and after Implementation of Radiosurgery

“…The goal of srs is tumour ablation, analogous to surgery. However, srs is minimally invasive and can routinely treat multiple lesions 4 , making srs an attractive treatment option in the setting of nsclc with bMets, for which both length and quality of life are the goals of treatment 10 .…”

“…The improved toxicity profile associated with newer radiation techniques such as stereotactic radiosurgery (srs)-in particular, the reduction in late toxicities-has led to a paradigm shift in treatment 4 . The sophisticated planning and imaging techniques in srs target cranial lesions with high levels of precision 8 , permitting an escalation of the radiation dose to the target lesion or lesions, while sparing the surrounding normal tissues [5][6][7][8][9][10][11] . Traditional wbrt has been supplemented with, and more recently replaced by, srs alone [5][6][7][8][9] .…”

“…The goals of treatment are to minimize toxicity and to maximize both length and quality of life 10,11 . Previous evaluation of a cohort of nsclc patients with bMets at our institution treated primarily with whole-brain radiation therapy (wbrt) with or without surgery demonstrated a median survival of approximately 4 months from diagnosis with bMets 12 .…”

Treatment of brain metastases

“…Results Soffietti et al (2013) analyzed the aspects of quality of life based on the EORTC QLQ-C30 scale in patients undergoing radiosurgery/surgery alone or combined treatment. Patients who underwent combined treatment had poorer overall quality of life at 9 months (p=0.014) (level of evidence 2B).…”

New Approaches to Melanoma Treatment: Checkpoint Inhibition with Novel Targeted Therapy

“…Additionally, WBRT has been shown to negatively impact quality of life for some patients receiving this treatment as an adjuvant to other therapies [3,4]. Because of these drawbacks, WBRT has been limited to use in patients with widespread or large volume brain metastases.…”