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Radiation Offers Better Prognosis After Brain Cancer Surgery CHICAGO, IL -- Nov. 3, 1998 -- Patients who undergo surgery to remove a tumour that has spread to the brain, followed immediately by radiation therapy, have fewer recurrent brain tumours and are less likely to die from the disease than patients who have surgery alone, according to an article in tomorrow’s issue of The Journal of the American Medical Association. Roy Patchell, M.D., of the University of Kentucky Medical Center in Lexington, and colleagues studied 95 patients who underwent surgery between 1989 to 1997 to remove a single metastasised tumour in the brain (a cancer that had spread from another cancer source in the body) to determine if radiotherapy (radiation therapy) following surgery improves neurological control of the disease and increases survival. Forty-nine of the patients were randomly assigned to receive radiotherapy immediately following surgery and 46 patients had surgery but not radiotherapy (observation group). "The addition of postoperative radiotherapy resulted in substantially better control of tumour in the brain than did treatment with surgery alone," the researchers write. Postoperative radiotherapy lessened the risk of brain cancer recurrence, reduced the risk of developing recurrence of a tumour at the same site in the brain and prevented subsequent development of tumours in different parts of the brain other than the original tumour site. The recurrence rate of tumour anywhere in the brain was significantly less in the radiation group (18 percent) than in the observation group (70 percent). Recurrence of a tumour at the original site in the brain was significantly lower in the radiation group (10 percent) than in the observation group (46 percent) and the average time from treatment to the development of recurrence of a tumour at the original site was significantly longer in the radiation group (more than 50 weeks) than in the observation group (27 weeks). The researchers also found that overall length of survival was not significantly different between the two groups. The median length of survival in the patients in the radiation group was 48 weeks; the patients in the observation group survived a median of 43 weeks. But postoperative radiotherapy prevented death due to neurologic causes. Of all patients who died (43 in the radiation group and 39 in the observation group), 14 percent in the radiation group died of neurologic causes, compared to 44 percent in the observation group. Also, for those in the radiation group that did die of neurologic causes, radiotherapy delayed the death much longer than the other group. However, patients in the radiation group were more likely to die of their systemic cancer (original source of cancer in the body) than as a result of neurologic progression of the brain tumour. Of all patients who died, 84 percent in the radiation group died systemic deaths, compared with 46 percent in the observation group. The researchers believe the study results show that surgery alone does not always eliminate microscopic disease and that postoperative MRI testing is not reliable for detecting the presence of residual tumour after a complete resection (surgical removal of the cancerous tissue). They say 46 percent of patients treated with surgery alone had recurrence at the site of original tumour, but postoperative radiotherapy reduced the recurrence rate to 10 percent. "Postoperative radiotherapy significantly prevented and delayed death due to neurologic causes, which is all that can be expected of a treatment directed solely at brain disease," they write. "The reduction in neurologic death was not present in patients who did not receive radiotherapy in the immediate postoperative period but were instead given [radiotherapy] only at recurrence. "Neurologic death involves the inexorable loss of mental and physical abilities and is the most difficult type of death for patients and their families to deal with. The prevention of a significant number of neurologic deaths is justification for the routine use of postoperative radiotherapy." Related Links: Journal of the American Medical Association E-mail this page to a friend or colleague! To print, use this version