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IFRT offers viable alternative to WBRT

Al Musella's Comments: (This is his personal views and are not necessarily the views of the Musella Foundation!)

Whole brain radiation is traditionally used when someone has a metastatic brain tumor. This article shows a small study which shows a limited field may be just as useful, with less side effects. This is not  controlled trial where they randomized 1/2 of the patients to involved field radiation and compared them to the half who got whole brain, so although it looks encouraging, so I would love to see others repeat it to make sure it is valid.  But it is something to consider.


Posted on: 03/26/2013

IFRT offers viable alternative to WBRT
Connolly EP. Neuro Oncol. 2013;doi:10.1093/neuonc/nos328.
March 21, 2013
Involved-field radiation therapy achieved reasonable locoregional control among certain patients with newly diagnosed single brain metastases who underwent surgical resection, according to study results.
Whole-brain radiation therapy (WBRT) has been shown to reduce local recurrence among patients who undergo surgical resection of brain metastases; however, it also is associated with delayed neurotoxicity.
To avoid that toxicity, surgeons at New York University Langone Medical Center have used involved-field radiation therapy (IFRT) in well-selected patients with surgically resected single brain metastases, according to background information in the study.
Eileen P. Connolly
Eileen P. Connolly, MD, PhD, of the department of radiation oncology at New York University Langone Medical Center, and colleagues conducted the investigation to evaluate the long-term outcomes of these patients.
The researchers evaluated 33 consecutive patients with single brain metastases from a known primary tumor.
All patients underwent gross total resection followed by IFRT. The investigators administered conformal radiation therapy (40.05 Gy in 15 fractions) to the postoperative surgical bed.
Patients underwent neurological exams and serial MRI during follow-up. Salvage treatment — including surgery, WBRT or sterotactic radiosurgery — was performed as necessary.
Median follow-up was 16 months (range, 2-65 months).
Connolly and colleagues reported local control of 90.3% at 12 months and 85.5% at 24 months; distant brain recurrence-free survival of 60.7% at 12 months and 51.4% at 24 months; and OS of 65.6% at 12 months and 61.5% at 24 months.
Thirteen patients (39%) developed recurrence at a new intracranial site, and five patients (15%) developed recurrence at the resection cavity, according to researchers.
Fourteen patients received salvage treatment. Eight underwent sterotactic radiosurgery, two underwent WBRT, two underwent surgery, and two received both IFRT and chemotherapy.
Four patients died of central nervous system progression.
“For patients with newly diagnosed single brain metastases treated with surgical resection, postoperative IFRT to the resection cavity achieves reasonable rates of local control and is an excellent alternative to WBRT,” Connolly and colleagues wrote.


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