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Association of Long-term Outcomes With Stereotactic Radiosurgery vs Whole-Brain Radiotherapy for Resected Brain Metastasis: A Secondary Analysis of The N107C/CEC.3 (Alliance for Clinical Trials in Oncology/Canadian Cancer Trials Group) Randomized Clinical Trial.
Palmer, Joshua D; Klamer, Brett G; Ballman, Karla V; Brown, Paul D; Cerhan, Jane H; Anderson, S Keith; Carrero, Xiomara W; Whitton, Anthony C; Greenspoon, Jeffrey; Parney, Ian F; Laack, Nadia N I; Ashman, Jonathan B; Bahary, Jean-Paul; Hadjipanayis, Costas G; Urbanic, James J; Barker, Fred G; Farace, Elana; Khuntia, Deepak; Giannini, Caterina; Buckner, Jan C; Galanis, Evanthia; Roberge, David.
Afiliación
  • Palmer JD; The James Cancer Center at The Ohio State University, Columbus.
  • Klamer BG; Center for Biostatistics, The Ohio State University, Columbus.
  • Ballman KV; Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota.
  • Brown PD; Weill Cornell Medicine, New York, New York.
  • Cerhan JH; Mayo Clinic, Rochester, Minnesota.
  • Anderson SK; Mayo Clinic, Rochester, Minnesota.
  • Carrero XW; Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota.
  • Whitton AC; Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, Minnesota.
  • Greenspoon J; Juravinski Cancer Centre, Hamilton, Ontario, Canada.
  • Parney IF; Juravinski Cancer Centre, Hamilton, Ontario, Canada.
  • Laack NNI; Mayo Clinic, Rochester, Minnesota.
  • Ashman JB; Mayo Clinic, Rochester, Minnesota.
  • Bahary JP; Mayo Clinic, Phoenix/Scottsdale, Arizona.
  • Hadjipanayis CG; CHUM, Montreal, Quebec, Canada.
  • Urbanic JJ; Mount Sinai Beth Israel, New York, New York.
  • Barker FG; University of California, San Diego, Moores Cancer Center, La Jolla, California.
  • Farace E; Massachusetts General Hospital Cancer Center, Boston, Massachusetts.
  • Khuntia D; Penn State University College of Medicine, Hershey, Pennsylvania.
  • Giannini C; Precision Cancer Specialists and Varian Medical Systems, Palo Alto, California.
  • Buckner JC; Mayo Clinic, Rochester, Minnesota.
  • Galanis E; Mayo Clinic, Rochester, Minnesota.
  • Roberge D; Mayo Clinic, Rochester, Minnesota.
JAMA Oncol ; 8(12): 1809-1815, 2022 12 01.
Article en En | MEDLINE | ID: mdl-36264568
Importance: Long-term outcomes of radiotherapy are important in understanding the risks and benefits of therapies for patients with brain metastases. Objective: To determine how the use of postoperative whole-brain radiotherapy (WBRT) or stereotactic radiosurgery (SRS) is associated with quality of life (QOL), cognitive function, and intracranial tumor control in long-term survivors with 1 to 4 brain metastases. Design, Setting, and Participants: This secondary analysis of a randomized phase 3 clinical trial included 48 institutions in the US and Canada. Adult patients with 1 resected brain metastases but limited to those with 1 to 4 brain metastasis were eligible. Unresected metastases were treated with SRS. Long-term survivors were defined as evaluable patients who lived longer than 1 year from randomization. Patients were recruited between July 2011 and December 2015, and data were first analyzed in February 2017. For the present study, intracranial tumor control, cognitive deterioration, QOL, and cognitive outcomes were measured in evaluable patients who were alive at 12 months from randomization and reanalyzed in June 2017. Interventions: Stereotactic radiosurgery or WBRT. Main Outcomes and Measures: Intracranial tumor control, toxic effects, cognitive deterioration, and QOL. Results: Fifty-four patients (27 SRS arm, 27 WBRT arm; female to male ratio, 65% vs 35%) were included for analysis with a median follow-up of 23.8 months. Cognitive deterioration was less frequent with SRS (37%-60%) compared with WBRT (75%-91%) at all time points. More patients declined by 2 or more standard deviations (SDs) in 1 or more cognitive tests for WBRT compared with SRS at 3, 6, and 9 months (70% vs 22%, 46% vs 19%, and 50% vs 20%, respectively). A 2 SD decline in at least 2 cognitive tests was associated with worse 12-month QOL in emotional well-being, functional well-being, general, additional concerns, and total scores. Overall QOL and functional independence favored SRS alone for categorical change at all time points. Total intracranial control for SRS alone vs WBRT at 12 months was 40.7% vs 81.5% (difference, -40.7; 95% CI, -68.1% to -13.4%), respectively. Data were first analyzed in February 2017. Conclusions and Relevance: The use of SRS alone compared with WBRT resulted in less cognitive deterioration among long-term survivors. The association of late cognitive deterioration with WBRT was clinically meaningful. A significant decline in cognition (2 SD) was associated with overall QOL. However, intracranial tumor control was improved with WBRT. This study provides detailed insight into cognitive function over time in this patient population. Trial Registration: ClinicalTrials.gov Identifier: NCT01372774; ALLIANCE/CCTG: N107C/CEC.3 (Alliance for Clinical Trials in Oncology/Canadian Cancer Trials Group).
Asunto(s)

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias Encefálicas / Radiocirugia Tipo de estudio: Clinical_trials / Prognostic_studies / Risk_factors_studies Aspecto: Patient_preference Límite: Adult / Female / Humans / Male País/Región como asunto: America do norte Idioma: En Revista: JAMA Oncol Año: 2022 Tipo del documento: Article Pais de publicación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Neoplasias Encefálicas / Radiocirugia Tipo de estudio: Clinical_trials / Prognostic_studies / Risk_factors_studies Aspecto: Patient_preference Límite: Adult / Female / Humans / Male País/Región como asunto: America do norte Idioma: En Revista: JAMA Oncol Año: 2022 Tipo del documento: Article Pais de publicación: Estados Unidos