Radiotherapy seemingly offers longer life to patients with recurrent brain cancer

Use of chemotherapies and targeted therapies is more often than not accompanied with side effects. According to experts at Thomas Jefferson University, patients who were given hypofractionated stereotactic radiotherapy (H-SRT) for their recurrent brain cancers lived longer lives.

In addition to offering longer survival, patients it was observed also did not experience side effects that were otherwise common. This discovery could help set a new standard for the treatment of recurrent gliomas.

“In many centers, patients with tumor progression within six months after the initial conformal radiotherapy are denied a second radiotherapy course (such as H-SRT), based on the assumption that their prognosis is poor. Our findings support the recommendation that essentially all patients with progressive high-grade gliomas, who are in good shape and have tumors amenable to local radiotherapy, should be considered for H-SRT,” commented senior author Maria Werner-Wasik, M.D., professor of Radiation Oncology at Jefferson Medical College of Thomas Jefferson University and Co-Director of the Stereotactic Radiosurgery Program at Jefferson Hospital for Neuroscience.

The study involved nearly 147 patients and is said to be the largest published series to analyze re-irradiation of recurrent high grade gliomas employing H-SRT. Median survival was seemingly found to be around 11 months when H-SRT was used post progression of cancer. When compared, the newest targeted therapy was seen to deliver survival of around six months after the recurrence of cancer as per the scientists.

“These results are dramatic and we hope our experience influences how physicians treat patients with recurrent brain cancer,” mentioned co-author David Andrews, M.D., professor of Neurological Surgery and Co-Director of the Stereotactic Radiosurgery Program. “We will need to design a randomized clinical trial to compare this method of treatment with current standard of care, and these data provide a compelling foundation for the design of such a trial.”

The part played by chemotherapy with radiation therapy is said to be unclear for gliomas that are recurrent. Also there seem to have been very few reported studies.

“While not a randomized trial, our study did not demonstrate a survival advantage in combining chemotherapy with H-SRT at recurrence compared to patients who received H-SRT alone,” mentioned the study’s first author, Shannon Fogh, M.D., chief resident, Radiation Oncology at Thomas Jefferson University Hospital. “We feel it is important for clinicians to consider this before adding other therapy with associated toxicity and cost.”

Pioneered by Thomas Jefferson University Hospital, this particular technology uses a stereotactic linear-accelerator-based radiosurgery unit that proffers tightly focused beams of radiation to tumor. It does this while sparing the surrounding normal tissue. For this, it uses both magnetic resonance imaging (MRI) and computerized tomography (CT) images to reveal a three-dimensional representation of a tumor. Thus images are both anatomically and spatially exact. In doses that seem to conform precisely to the tumor, the radiation is delivered. Physicians may thus have the ability to use much higher doses over shorter periods of time by irradiating just the tumor and sparing the normal tissue in the brain.

“We can give a dose that is 50 percent beyond what has been considered the maximum dose of radiation the brain can tolerate,” said Dr. Andrews. “We have learned over a 15 year experience that this dose is not only safe, but has almost doubled survival for these patients.”

“Perhaps the most surprising and relevant finding from our review is a good prognosis in patients who recurred shortly after initial treatment,” Dr. Fogh added. “Only two prior studies have examined prognosis in patients who recur shortly after treatment, and they showed conflicting results. It may be that the larger number of patients examined in our study, compared to the others, allowed us to more accurately assess this phenomenon.”

Unlike five or six weeks for standard fractionation, H-SRT can be delivered over just two weeks. The experts discovered that younger patients had the longest survival when treated with H-SRT after recurrence. They apparently also had smaller tumors and a reduced time between diagnosis and recurrence.

The findings were reported online in the Journal of Clinical Oncology.