The first set of guidelines dealing with cancer that has spread to the brain calls for treatment with both surgery and radiation therapy instead of just radiation alone.
The document, released today at the Congress of Neurological Surgeons meeting in New Orleans, is designed to clarify the best treatments for brain metastases and identify areas where more research is needed, said Dr. Steven Kalkanis, co-director of the Hermelin Brain Tumor Center at Henry Ford Hospital in Detroit and a member of the panel of experts who developed the guidelines.
Among 1.4 million individuals with cancer in the United States, 30% to 40% will develop brain metastases -- tumors that travel to the brain from other areas in the body, such as the breast or lung. It's common practice to treat patients with whole brain radiation. However, a review of medical literature shows that the best results are obtained when patients have surgery to remove the brain tumors followed by whole brain radiation, Kalkanis said.
"An exhaustive search of the data clearly shows you can't just do surgery or whole brain radiation. You need to do both. Surgery followed by whole brain radiation is much better," he said.
A newer treatment for brain metastases, called stereotactic radiosurgery, can be considered an alternative to surgery and whole brain radiation, according to the guidelines. In this type of treatment, focused radiation beams are aimed at the lesions in the brain.
"There is new data that shows simply doing radiosurgery has similar results as doing surgery and whole brain radiation," Kalkanis said. "They are equivalent."
Stereotactic radiosurgery may be the best option for patients with lesions that are hard to reach surgically, he said.
The guidelines, however, do not recommend chemotherapy for brain metastasis. Chemotherapy is often correctly used to treat a primary tumor but does not appear helpful for brain metastases, according to studies.
The guidelines also have identified areas in need of more research and list clinical trials that may help resolve some outstanding questions. However, treatment for brain metastases has improved tremendously and should further benefit by consistent application of the guidelines, Kalkanis said.
"If you look over the last 15 years, there has been a dramatic shift," he said. "It used to be that patients with brain metastases died from it. Now it's no longer a death sentence. We are able to control brain metastases better and better."
The guidelines will be published in December in a special issue of the Journal of Neuro-Oncology.
-- Shari Roan
Photo: A doctor stands by images of a CT scan showing a brain with cancer. Credit: Robert Gauthier / Los Angeles Times.