E-Newsletter - August 2016

Harmful Impact on Cognitive Function Outweighs Benefits of Whole Brain Radiotherapy

Final Results from NCCTG (Alliance) N0574 – A Phase III Randomized Trial of the Role of Whole Brain Radiation Therapy in Addition to Radiosurgery in the Management of Patients with One to Three Cerebral Metastases

The Alliance for Clinical Trials in Oncology’s phase III trial, NCCTG (Alliance) N0574, testing the role of whole brain radiotherapy (WBRT) in addition to radiosurgery in patients with small brain metastases from other tumor types provides a definitive answer on quality of life and cognitive function after adjuvant WBRT. Final research results published online by The Journal of the American Medical Association [JAMA. 2016;316(4):401-409] support a recommendation of initial treatment with stereotactic radiosurgery (SRS) alone and close monitoring to preserve cognitive function in patients with newly diagnosed brain metastases treatable with SRS.

This study for the first time used decline in cognitive function at three months as the primary endpoint. Cognitive deterioration at three months was significantly more frequent in patients in the WBRT+SRS group than those in the SRS alone group, involving especially immediate recall, memory, and verbal fluency. As with prior studies, intracranial disease control was improved with WBRT but there was no improvement in overall survival. Although WBRT decreases brain tumor progression, the accompanying decline in cognitive function outweighs the benefits for many patients. The results of this study settle an ongoing debate on whether patients with small brain metastases should undergo WBRT following SRS.

“Over time, there’s been a general shift in moving away from using whole brain radiation in favor of stereotactic radiosurgery,” said Paul D. Brown, MD, the lead study author. “With these results and appropriate concerns for cognitive decline, it will likely be pushed even further, reserving WBRT for later in a patient’s disease course.” Dr. Brown is a Professor of Radiation Oncology at the University of Texas MD Anderson Cancer Center, and the study’s co-chair.


For other articles in the August issue of the Alliance E-News newsletter, see below.