A randomized trial of surgery in the treatment of single metastases to the brain

Article Abstract:

Metastases, secondary cancers which have spread from the original tumor to other sites in the body, are the most common type of intracranial tumor. Patients with metastases in the brain have a very poor prognosis, usually surviving from three to six months despite radiation treatment. Chemotherapy seems to be ineffective. Because about half the cases of brain metastasis involve only a single tumor, it should, in principle, be possible to treat some patients surgically. Past research has been biased, however, and has failed to establish the efficacy of surgical treatment, since only patients with milder disease have been sent to surgery and the worst cases have received radiotherapy. For this reason a randomized trial was begun using patients over 18 years with evidence of only a single tumor in the brain. Between October 1985 and December 1988, 54 patients agreed to participate in the study; six were later discovered to have primary brain tumors, rather than metastases, and were eliminated from the analysis. Of the 48 actual participants, 25 were randomly assigned to the surgical group and 23 to the radiotherapy group. Analysis showed quality of life, as judged by the patients' abilities to care for themselves, to be much improved for the surgery group (independence for a median of 38 weeks) over the radiotherapy group (median independent care of 8 weeks). The surgical group had fewer recurrences of tumor and a median survival time of 54 weeks, as opposed to 23 weeks in the radiation group. Since only half of all patients with brain metastases have only one tumor, and only half of them have a tumor in a location amenable to surgery, about 25 percent of patients with metastatic brain tumors may enjoy extended survival as a result of surgery. For the remainder, radiotherapy is the only alternative. (Consumer Summary produced by Reliance Medical Information, Inc.)

Surgery

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Postoperative Radiotherapy in the Treatment of Single Metastases to the Brain: A Randomized Trial

Article Abstract:

Whole-brain radiation therapy (WBRT) following surgical removal of a solitary metastatic brain tumor appears to reduce the rate of tumor recurrence and lower the risk of neurological death. Researchers assigned 95 patients with a single metastatic brain tumor to WBRT,or no additional treatment, following surgical tumor resection. Another brain tumor developed in 70% of untreated patients and only 18% of patients who underwent WBRT. Death from neurologic causes occurred in 44% of untreated patients and 14% of treated patients. Postoperative radiotherapy did not improve overall survival, but it was significantly more effective than surgery alone in controlling the brain tumor.

Brain tumors

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Treatment of a Single Brain Metastasis: the role of radiation following surgical resection

Article Abstract:

Postoperative whole-brain radiation therapy following surgical removal of a solitary metastatic brain tumor substantially reduces the likelihood of local or distant cancer recurrence. Researchers compared tumor patients in whom complete surgical tumor resection was followed by radiation, or no additional treatment. Brain cancer recurred in 18% of patients treated with radiation, compared to 70% of patients who had surgery alone. Postoperative radiation did not improve functional independence or patient survival.

Editorial

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