When Treating Tumors, Smaller Radiation Fields Can Spare Brain

Patients suffering from aggressive brain tumors can be effectively treated with smaller radiation fields to spare the rest of the brain and preserve cognition.

“For patients with glioblastoma, we now know we can safely and effectively treat them with smaller radiation fields to spare the rest of their normal brain,” said lead investigator Michael D. Chan, MD, assistant professor of radiation oncology at Wake Forest Baptist Medical Center (Winston-Salem, NC, USA). That’s important because it lessens the symptoms from radiation toxicity like tiredness and nausea.”

According to Dr. Chan, that a patient’s cognition is related to how much of the healthy brain is irradiated, therefore, targeting radiation on smaller areas of the brain may help preserve cognition and does not seem to lead to an increase in the probability of tumor recurrence. Overall, while long-term survival rates for glioblastoma multiforme (GBM) patients have not improved by much with treatment advances, the ability to treat with smaller radiation fields preserves cognition and provides the possibility of better quality of life.

Recent research findings from Dr. Chan and colleagues appeared online December 2013 ahead of print in the American Journal of Clinical Oncology. Whereas there have been other comparable studies, this one is the largest to compare smaller radiation margins to larger ones to document differences in patterns of failure for patients, according to Dr. Chan. For this retrospective study, records for 161 patients treated at Wake Forest Baptist over the last 10 years were reviewed.

“We decided a few years ago that it would be worthwhile to look at whether using these tighter margins would affect the tumors coming back outside of the radiation field, or tell us if we are barely missing,” Dr. Chan stated. “We are the first to show definitively that people with smaller margins don’t do any worse than those with larger margins.”

Dr. Chan reported that Wake Forest Baptist’s Edward G. Shaw, MD, professor of radiation oncology, in the 1990s, was part of a team that began first using smaller margins because it was less toxic. Smaller radiation margins around the tumor do not seem to lead to an increase in the tumor returning just outside of the radiation field, according to Dr. Chan. A smaller radiation field, combined with sophisticated treatment techniques, such as newer radiation technologies and chemotherapy agents, provides physicians with more alternatives.

“Treatments have gotten better over time and people with GBM may live longer than they had in the past. Our study found that the margins did not affect where the GBM came back or how long it took it to come back and it did not affect the overall survival,” Dr. Chan concluded. “This could potentially be practice changing.”

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Wake Forest Baptist Medical Center