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Two doctors from Carolinas HealthCare System have been dedicated to improving both the treatment and quality of life for patients with brain tumors.
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Dr. Anthony Asher and Dr. Stuart Burri conceived and developed an international trial in Charlotte, at Carolinas Medical Center, over 10 years ago.
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Their study that was accepted for publication by the Journal of the American Medical Association (JAMA).
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The study, released on July 26, 2016, shows that patients with the most common form of brain tumor can be treated in an effective and substantially less toxic way by omitting a widely used portion of radiation therapy.
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These results will allow tens of thousands of patients with brain tumors to experience a better quality of life while maintaining the same length of life.
New research has demonstrated that the most common type of brain cancer can be effectively treated with less toxic forms of radiation therapy. The results of the study, which Carolinas Healthcare System helped lead, will allow tens of thousands of patients with these brain tumors have a better quality of life while maintaining the same length of life.
Because of their location, these tumors often produce severe neurological symptoms, such as headaches, weakness or problems with speech and information processing, thereby compromising both daily function and quality of life in cancer patients. Typical therapies for these types of brain tumors include surgery, whole brain radiation therapy and focused radiation.
"The first and highest rule of medical care is 'do no harm," said Anthony L. Asher, MD, FACS, director of Carolinas HealthCare System Neurosciences Institute and the senior author on the report. "Consistent with that obligation, when it isn't possible to extend survival with various therapies, it's absolutely essential that we work to reduce or eliminate any possibility that quality of life will be compromised by treatments."
Asher and Stuart H. Burri, M.D. Chairman, Radiation Oncology at Carolinas HealthCare System's Levine Cancer Institute, began their research on this subject over 10 years ago in Charlotte, North Carolina. Along with Dr. Paul Brown at Mayo Clinic, they spearheaded an international, multi-institutional, randomized trial which was published in the Journal of the American Medical Association.
According to the American Cancer Society, in 2016, there will be approximately 1.7 million new cancer cases diagnosed in the United States. Almost one in four of those patients (about 400,000) will experience spread of their cancers to the brain. In contrast, 300,000 and 240,000 patients will be newly diagnosed with breast and primary lung cancers, respectively, each year.
"Whole brain radiation patients also reported worse quality of life compared with patients who only received the focused radiation," said Burri. "Interestingly, the data showed that the addition of whole brain radiation produced no improvement in survival."
The trial authors concluded that the benefit of adding whole brain radiation was outweighed by its risks in patients with one to three newly diagnosed brain metastases. This is a very relevant finding, as over 200,000 patients still receive whole brain radiation in the United States each year, and the majority of patients with brain metastases have a limited number (typically three or less) of brain lesions. Drs. Asher and Burri, along with their co-investigators, now recommend that patients with one to three brain metastases should no longer receive routine whole brain radiation therapy, and should be treated with focused therapy alone to better preserve cognitive function and quality of life.
"In the past, clinicians who treated patients with brain tumors seldom used sophisticated techniques like neurocognitive tests to evaluate patients' daily function in response to various therapies,” said Burri. “Without those tests, we might have incorrectly concluded that whole brain radiation was a better option for patients because it made their scans look better, at least in the short term. However, the data from our study shows that clinicians can no longer simply rely on the results of traditional lab tests or scans to assess the value of care; we have to understand the total impact of cancer therapies on our patients."
Asher and Burri are now working on a new method of focused therapy for tumors that have spread to the brain that combines radiation and surgery. The technique was pioneered at Levine Cancer Institute and they are looking to expand and further validate the approach with the National Cancer Institute.
