Therapy for patients with brain tumor metastases often includes removal of the stable solid metastases followed by whole-brain radiotherapy (WBRT), but this treatment has been the subject of much discussion. Arguments in favor of WBRT include the desire limit the deleterious effects of disease progression on cognitive functioning, while arguments against using WBRT include the risk of long-term neurotoxicity. The discussion is further complicated, because many patients with brain metastases are under palliative care, and health-related quality of life (HRQOL) is a very important consideration.
In 2011, EORTC trial 22952-26001 concluded that WBRT following surgical or radio-surgical removal of brain metastases reduces relapses and neurologic deaths but does not improve how long patients remain functionally independent or their overall survival. Now, health-related quality of life (HRQOL) results from this same EORTC trial show 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.
Dr. Riccardo Soffietti, Head of the Neuro-Oncology Department at the University of Torino and the Coordinator of this study, says “The results of the analysis of quality of life within this EORTC Trial reinforces the result of the survival analysis, and ultimately the concept that delaying radiotherapy at tumor progression can now be considered a safe option and put into the recommendations for daily clinical practice”.
This academic EORTC sponsored trial included 359 patients (180 patients in the WBRT arm and 179 patients in the observation arm) from 33 institutions located in Belgium, Finland, France, Germany, Israel, Italy, Portugal, Spain, Switzerland, Turkey and the United Kingdom.
For additional information concerning this topic, please see the accompanying editorial in the Journal of Clinical Oncology in which Atif J. Khan of Rutgers University’s Robert Wood Johnson Medical School in Piscataway and Adam P. Dicker of Thomas Jefferson University’s Jefferson Medical College in Philadelphia discuss the merits and limits of whole-brain radiotherapy. Also, Dr David Osoba, Professor (retired) in the Department of Medicine at University of British Columbia in Vancouver, comments on these results in a podcast concerning “Management of Metastases to the Brain: A therapeutic Conundrum”.
EORTC, Medical Science Writer