for those choosing between whole brain rad therapy and stereotactic (gamma or cyberkn

[Lani]

ife) the following, fresh off the press, may help in your deliberations. Obviously, only a radiation therapist with expertise can advise you as to whether your tumor is "limited" and whether there are likely to be other sites involved, whether the size of your lesion is best dealt with one way or the other, but this is the first time I have seen objectified evidence of visible changes which occurred with wbr but not with srs (with one exception in the article below)


J Neurooncol. 2014 Dec 2. [Epub ahead of print]
White matter changes in breast cancer brain metastases patients who undergo radiosurgery alone compared to whole brain radiation therapy plus radiosurgery.
Stokes TB1, Niranjan A, Kano H, Choi PA, Kondziolka D, Dade Lunsford L, Monaco EA 3rd.
Author information
Abstract
Delayed toxicity after whole brain radiation therapy (WBRT) is of increasing concern in patients who survive more than one year with brain metastases from breast cancer. Radiation-related white matter toxicity is detected by magnetic resonance imaging (MRI) and has been correlated with neurocognitive dysfunction. This study assessed the risk of developing white matter changes (WMC) in breast cancer patients who underwent either WBRT plus stereotactic radiosurgery (SRS) or SRS alone. We retrospectively compared 35 patients with breast cancer brain metastases who received WBRT and SRS to 30 patients who only received SRS. All patients had evaluable imaging at a median of one year after their initial management. The development of white matter T2 prolongation as detected by T2 or FLAIR imaging was graded: grade 1 = little or no white matter T2 hyperintensity; grade 2 = limited periventricular hyperintensity; and grade 3 = diffuse white matter hyperintensity. After WBRT plus SRS, patients demonstrated a significantly higher incidence of WMC (p < 0.0001). After one year, 71.5 % of patients whose treatment included WBRT demonstrated WMC (42.9 % grade 2; 28.6 % grade 3). Only one patient receiving only SRS developed WMC. In long-term survivors of breast cancer, the risk of WMC was significantly reduced when SRS alone was used for management. Further prospective studies are necessary to determine how these findings correlate with neurocognitive toxicity. WBRT usage as initial management of limited brain disease should be replaced by SRS alone to reduce the risk of delayed white matter toxicity.
PMID: 25445836 [PubMed - as supplied by publisher]