New research was presented at ASTRO 2020, the virtual American Society for Radiation Oncology Annual Meeting, from October 24-28.
Although previous studies support stereotactic radiosurgery (SRS) as the standard of care in patients with cancer with up to three brain metastases due to better preservation of cognitive function and similar overall survival when compared with whole-brain radiation therapy (WBRT), whether SRS should be used for the many patients who present with numerous (4-15) brain metastases remains unclear. Between 2012 and 2019, researchers randomized patients with four to 15 brain metastases to SRS or WBRT. At 4 months, patients in the SRS group had an average z-score increase of 0.21 from baseline on the Hopkins Verbal Learning Test-Revised Total Recall, compared with a decline of 0.74 in the WBRT group. Patients in the SRS group also had statistically significant and clinically meaningful advantages in memory function over those in the WBRT group at 1 and 6 months. Overall survival in the intent-to-treat population was 7.8 months for those in the SRS arm, compared with 8.9 months in the WBRT arm. A clinically meaningful decline in cognitive function was experienced by 50% of the WBRT arm, compared with just 6% in the SRS arm. While 4-month local control rates favored SRS over WBRT (95% vs 87%), distant brain control rates favored WBRT over SRS (80% vs 60%).