These results suggest that adding stereotactic radiation therapy to traditional whole-brain radiation therapy prolongs the survival of patients with single brain metastases without greatly increasing the side effects. Quality-of-life measurements and quality-adjusted life years were not reported, however. Moreover, this study did not address the question of whether delivering the boost dose of radiation by stereotactic radiation therapy was better than a boost delivered by traditional radiation therapy.
At present, there is no evidence from randomized clinical trials that the survival of patients with metastatic cancer in the brain is better, or the side effects decreased, if they are treated by intensity-modulated radiation therapy (IMRT), proton radiation therapy, or carbon-ion radiation therapy instead of traditional radiation therapy with or without stereotactic radiation therapy.
Glioblastoma
In one arm of a prospective randomized trial,[2] traditional conformal radiation therapy was delivered to 286 patients suffering from glioblastoma, between 2000 and 2002. Following treatment, 50% of patients died within 12.1 months and 90% within 2 years.
On another arm of the same study, 287 patients received temozolomide(Drug information on temozolomide) (Temodar) in addition to traditional conformal radiation therapy. Following this treatment, survival was significantly improved, with 50% of patients dying within 14.6 months and 73.5% within 2 years (P < .001).
In patients receiving radiation alone, nonhematologic grade 3/4 toxicity developed in 15%, vs 31% among those receiving radiation plus temozolomide. The most common side effects were fatigue and other constitutional symptoms, rash and other dermatologic effects, infection, effects on vision, and nausea/vomiting.
• Stereotactic Radiation Therapy—In a prospective randomized trial,[26] 203 patients with newly diagnosed glioblastoma were randomized to treatment by conventional radiation therapy (plus carmustine(Drug information on carmustine) [BiCNU]), with vs without stereotactic radiation therapy, during 1994–2000. The results showed that the use of stereotactic radiation therapy did not improve survival, nor did it change the patterns of failure. The investigators also found no difference in the general quality of life and cognitive functioning between the two arms.
At present, there is no evidence from randomized clinical trials that the survival of patients with glioblastoma is better, or the side effects decreased, if they are treated by advanced technologies instead of or in addition to traditional conformal radiation therapy, with or without temozolomide.
Cancer of the Nasopharynx
In one arm of a prospective randomized trial,[6] traditional conformal radiation therapy (70 Gy in 1.8–2 Gy fractions over 7–8 weeks) was delivered to 92 patients suffering from nasopharyngeal cancer. Following treatment, 54% of patients died within 3 years. The patterns of failure revealed that 41% suffered local failure, while 43% developed distant metastases. On another arm of the same trial, 93 patients received chemotherapy in addition to traditional conformal radiation therapy. Following this treatment, 24% of patients died within 3 years, a significant improvement (P < .001). The patterns of failure revealed that 14% suffered local failure, whereas 15% developed distant metastases.
This series of case presentations (five individual cases) will provide oncologists and other healthcare professionals with strategies for evaluating evidence-based data on the latest treatments in metastatic breast cancer (MBC) and the application of that data into the development of individualized approaches to care, including overcoming resistance, in order to optimize management and outcomes for patients.
