Breaking News
June 22, 2018 - Measuring levels of ethyl sulphate in hair can help assess alcohol consumption
June 22, 2018 - Researchers develop robot bloodhound that can rapidly detect odors on the ground
June 22, 2018 - AAA doses first patients in two clinical studies with PSMA-R2 for prostate cancer
June 22, 2018 - Pelvic pain a major issue for women nearing mid-life, research reveals
June 22, 2018 - Researchers develop reliable DNA barcodes for biomedical research
June 22, 2018 - New risk-prediction model may help identify diabetic patients at high risk of pancreatic cancer
June 22, 2018 - Study reveals how mTORC1-driven changes in crowding could influence major diseases
June 22, 2018 - Researchers uncover new therapeutic opportunity in the treatment of malignant melanoma
June 22, 2018 - UC Riverside researcher receives grants to advance cancer, ALS research
June 22, 2018 - Radiation therapy alone may be enough to treat older, sicker patients with anal cancers
June 22, 2018 - Technical report describes how to make accurate particle size measurements on carbon black samples
June 22, 2018 - Nocdurna (desmopressin acetate) Approved by FDA as First Sublingual Tablet to Treat Nocturia due to Nocturnal Polyuria
June 22, 2018 - Neuroscientists locate neurons in the brain that respond when a visual target is found
June 22, 2018 - First human Keystone virus infection reported
June 22, 2018 - New study reveals how ‘good’ bacteria help in regulating our metabolism
June 22, 2018 - Osteopathic manual therapy affecting the diaphragm improves chronic low back pain
June 22, 2018 - Researchers create revolutionary model to study pulmonary diseases
June 22, 2018 - Diagnosing Heart Disease Using AI
June 22, 2018 - Increasing biodefense risks posed by synthetic biology
June 22, 2018 - Many Women Report Vasomotor Symptoms in Their 60s
June 22, 2018 - Rare mutation of gene carried by Quebec family gives insight into how the brain is wired
June 22, 2018 - Chemists find new way to make enzymes do a non-natural reaction
June 22, 2018 - Summer is good time to check for signs of skin cancer
June 22, 2018 - Innovative method can help identify patients with spastic cerebral palsy
June 22, 2018 - Exercise alters characteristics of blood to reduce inflammation in obese people
June 22, 2018 - Researchers examine complications across different types of breast reconstructive surgeries
June 22, 2018 - Rhesus macaque model could be useful to test therapies for congenital Zika virus syndrome
June 22, 2018 - AHA: New Insights Into Sickle Cell and Stroke Risk
June 22, 2018 - Doctors prescribe opioids at high rates to those at increased overdose risk
June 22, 2018 - Reduction in US cigarette smoking rates
June 22, 2018 - Preconception binge drinking may have negative effect on future offspring
June 22, 2018 - FDA expands approval of novel diabetes management device to include younger pediatric patients
June 22, 2018 - Researchers confirm weight loss benefits of the 16:8 diet
June 22, 2018 - FDA approves Eversense CGM system for use in adults with diabetes
June 22, 2018 - State opioid monitoring programs are not created equal
June 22, 2018 - Autistic teens who are bullied have higher rates of depression
June 22, 2018 - Penn Medicine team launches universal stroke awareness program
June 22, 2018 - Scientists discover the molecular trigger of necroptosis
June 22, 2018 - Researchers report unusually high levels of herpesvirus in the brains of people with Alzheimer’s disease
June 22, 2018 - Theoretical models predict how juveniles evolve to be more susceptible than adults to infection
June 22, 2018 - USC study reveals how the cell launches emergency response to repair damaged DNA
June 22, 2018 - $1.9 million grant aims to enhance behavioral health services in community-based settings
June 22, 2018 - New 3D imaging technique could improve arthritis treatment
June 22, 2018 - Cytokinetics Announces Data From Phase 2 Clinical Study of Reldesemtiv in Patients With Spinal Muscular Atrophy
June 22, 2018 - Polarized cells give the heart its fully developed form
June 21, 2018 - Stem cells appear to help fight obesity in animal models
June 21, 2018 - Harnessing Pediatric Cancer Genomic Data in the Cloud
June 21, 2018 - Training nursing students with cost-effective 3D-printed task trainers
June 21, 2018 - Study provides insight into how planned and spontaneous movements are processed in the brain
June 21, 2018 - Suicide Prevention | SAMHSA – Substance Abuse and Mental Health Services Administration
June 21, 2018 - From designer microbes to stem cells, researchers are investigating new strategies to treat bowel disease
June 21, 2018 - Study suggests state-of-the-art genomic testing for routine autopsy of stillbirths
June 21, 2018 - Christiana Care Health System opens first Epilepsy Monitoring Unit in Delaware
June 21, 2018 - CDC: Obesity Prevalence Higher in Non-Metropolitan Counties
June 21, 2018 - Youths Treated for Non-Suicidal Self Harm at Increased Risk of Suicide Within a Year
June 21, 2018 - WVU researchers increase colorectal cancer screening rates in West Virginia
June 21, 2018 - Pediatric kidney recipients often have subclinical inflammation
June 21, 2018 - OHSU Knight Cancer Institute Director wins 2018 Tang Prize in Biopharmaceutical Science
June 21, 2018 - Researchers study broader effects of neonics on wildlife
June 21, 2018 - Study provides new insight on how antibiotics affect the gut microbiome
June 21, 2018 - InHealth Technologies becomes exclusive distributor of RENÚ Voice, RENÚ Gel in the United States
June 21, 2018 - New analysis links higher BMI to lower breast cancer risk for younger women
June 21, 2018 - Interactive preclinical PET-MR workshop demonstrates benefits of multi-modality imaging
June 21, 2018 - Gene signature could improve early diagnosis of TB
June 21, 2018 - Psychiatric Drug Lithium Tied to Birth Defect Risk
June 21, 2018 - Preclinical study suggests ARID1a may be useful biomarker for immunotherapy
June 21, 2018 - Risks of cancer and mortality found to be lowest in light drinkers
June 21, 2018 - Fetal immune cells are fast-acting first responders to microbes in adulthood
June 21, 2018 - Researchers invent medical device for proliferation, differentiation of neural stem cells
June 21, 2018 - Study explores current understanding of human physiology, pathology, trauma and surgery in space
June 21, 2018 - Scientists explore interactions between chromosomes 12 and 17
June 21, 2018 - People with severe obesity constantly try to reduce or control their weight
June 21, 2018 - Relaxing ‘brain tingles’ may have benefits for both mental and physical health
June 21, 2018 - Breakthrough discovery reveals brain metals that may drive progression of Alzheimer’s disease
June 21, 2018 - New methods of fragment-based lead discovery to identify potential antibiotics
June 21, 2018 - Recovery and Treatment | NIH MedlinePlus the Magazine
June 21, 2018 - Study finds cell-free DNA profiling as versatile method to monitor UTIs
June 21, 2018 - ‘Hidden’ driver discovered that helps prime the anti-tumor immune response
June 21, 2018 - Groundbreaking discovery could be key to preventing cancer metastasis
June 21, 2018 - Impulse control disorders found to be more common in people taking Parkinson’s drugs
Study explores use of radiosurgery in lung cancer patients with multiple brain metastases

Study explores use of radiosurgery in lung cancer patients with multiple brain metastases

image_pdfDownload PDFimage_print

Although targeted therapies have produced dramatic advances in our ability to control some types of advanced lung cancer, growth of the disease in the brain remains a major problem. Radiation is often used to treat deposits in the brain, but the best technique to deliver radiation can be controversial. Whole-brain radiation therapy, as its name suggest, treats the entire brain but can be associated with notable cognitive side effects. Another strategy, radiosurgery, directs highly-focused radiation only to the sites of metastasis, largely sparing the normal brain.

The challenge has been to define in which circumstances each technique is best. The debate has centered on the number of brain metastases, with the field generally agreeing that with three or fewer deposits, radiosurgery is the preferred approach, and then switching to the use of whole-brain radiation to treat four or more deposits.

A University of Colorado Cancer Center study published today in the Journal of Thoracic Oncology explores the use of radiosurgery in advanced lung cancer patients with four or more brain lesions – in some cases, dramatically more than four lesions – and shows that in a subset of patients, radiosurgery may be the best choice even when the number of brain lesions far exceeds the established three-lesion threshold.

In addition to discovering if radiosurgery could be effective in patients with greater than four brain lesions, the study hoped to answer two more important questions, namely, if you use radiosurgery to treat only the known sites of disease, might you be missing smaller deposits that would have been treated as a byproduct of whole-brain radiation, leading to worse long-term outcomes? And if you treat multiple sites with radiosurgery, at some point does the radiation dose to the normal parts of the brain become equivalent to that from whole-brain radiotherapy?

“It used to be that once lung cancer metastasized to the brain, the prognosis was poor. Whole brain radiation therapy decreases the risk of death from neurologic causes, but at a steep cost. This study suggests that for lung cancer patients on targeted therapies whose cancer has spread to the brain, the use of radiosurgery makes it rare to die of causes related to brain metastases,” says Tyler Robin, MD, PhD, senior resident in radiation oncology at the CU School of Medicine and the paper’s first author. Robin collaborated with senior author, Chad G. Rusthoven, MD, assistant professor in Radiation Oncology at the University of Colorado Cancer Center.

“Despite the fact that patients on this study had multiple brain metastases, the outcomes were excellent with radiosurgery alone, with overall survival measured on the order of years,” says Rusthoven.

The study also asked whether radiosurgery to multiple lesions is likely to subject patients to the same cognitive risks as whole-brain radiation therapy – in other words, if you are using radiosurgery to treat 5, 10, 15 or 20 brain lesions, at some point are you effectively irradiating the whole brain?

“Even when we treated over ten brain metastases in one session, the dose to the whole brain was phenomenally lower than with whole-brain radiotherapy,” Robin says.

The group measured radiation dose in two ways – to the whole brain and also specifically to the hippocampus, the brain structure responsible for processing new memories, which has been blamed for the cognitive side effects associated with brain radiation.

Whole-brain radiation delivers a radiation dose of approximately 30 gray (Gy) to the entire brain. A technique known as “hippocampal-sparing” or “hippocampal-avoidance” radiation delivers the same dose of radiation to the bulk of the brain, but only about 10 Gy to the hippocampus. The maximum radiation dose experienced with radiosurgery, even with many metastases, was 1.2 Gy in the hippocampus and 0.8 Gy across the whole brain.

“The very low doses of radiation to the normal brain observed with radiosurgery compared to whole-brain radiation has the potential to dramatically alter the risk of cognitive side effects,” says Rusthoven. “As the field of oncology evolves, we have to evolve with it. Patients with cancer who are eligible for targeted therapies are living longer than ever before, making treatment strategies that support long term quality of life even more important.”

Tagged with:

About author

Related Articles