When prescribing radiation therapy (RT) for cancer patients with brain metastases, a less-is-better approach may prove better for the patient with respect to both quality of life (QOL) and survival, according to an article published in the February issue of the American Journal of Clinical Oncology.
Cancer patients diagnosed with one to three brain metastases who received stereotactic radiosurgery (SRS), intensive follow-up observation, and salvage therapy only as necessary lived three times as long and experienced a better quality of life than comparable patients who received only SRS and whole-brain radiation therapy (WBRT) (Am J Clin Oncol, Vol. 35:1, pp. 45-50).
The patients were enrolled in a small, randomized trial at MD Anderson Cancer Center at the University of Texas. They were treated between 2000 and 2007 and were followed until they died or until the end of the clinical trial in 2009.
The 58 patients had an age range of 60 to 63 years; 31 patients were in the SRS group, and 27 patients were in the combination SRS and WBRT group. More than half of the patients in each group had lung cancer as the primary cancer. All were highly motivated to live as long as possible, according to lead author Lincy Lal, PhD, from Ingenix Consulting-Healthcare's division of pharmacy informatics in Missouri City, TX, and colleagues.
While 71% of the patients who did not receive the additional WBRT experienced recurrences by the time study enrollment had closed in May 2007, compared with only 15% of the other group, they survived longer and had a less debilitating quality of life. Patients who had both SRS and WBRT lived a median of 5.7 months, whereas the SRS group lived a median of 15.2 months.
A cost analysis showed that the SRS/observation/salvage therapy treatment was more expensive, at an average cost of $119,000, compared with $74,000 for the group who received both radiotherapy treatments.
The cost-effectiveness analysis showed that incremental costs were proportionately less than the incremental increase in a patient's survival and quality of life, the authors found. The additional costs were also within a commonly accepted willingness-to-pay threshold range for treating disease recurrence.
