The changing landscape of whole-brain radiation therapy
Menée à partir de l'analyse des données d'un essai japonais de phase III portant sur 88 patients atteints d'un cancer du poumon non à petites cellules et présentant 1 à 4 métastases cérébrales (durée médiane de suivi : 8 mois), cette étude évalue, du point de vue de la survie globale et de la toxicité, l'intérêt d'ajouter une radiothérapie du cerveau entier à une radiochirurgie stéréotaxique ciblant les métastases cérébrales
The Japanese Radiation Oncology Study Group (JROSG) 99-1 investigators1 conducted a randomized clinical trial (RCT) of stereotactic radiosurgery (SRS) with or without whole-brain radiation therapy (WBRT) in patients with 1 to 4 brain metastases. When originally published in 2006, the data suggested that the inclusion of WBRT improved rates of 12-month brain tumor recurrence and use of salvage brain treatment but not overall survival. In the secondary post hoc analysis in this issue of JAMA Oncology, Aoyama and colleagues2 conclude that treatment with WBRT plus SRS is significantly associated with improved overall survival compared with SRS alone in the cohort limited to non–small-cell lung cancer (NSCLC) with a favorable prognosis (disease-specific Graded Prognostic Assessment 2.5-4.0). In the current era of personalized medicine, this is an appropriate attempt to renew interest in a subset of patients who may derive a survival benefit from WBRT using prospectively gathered data. However, the landscape of managing multiple brain metastases is complex and rapidly changing. The decision to use WBRT revolves around its impact on 3 interrelated components: (1) overall survival, (2) intracranial control, and (3) neurocognitive sequelae.
JAMA Oncology , commentaire en libre accès, 2014