Neurocognitive and neuroendocrine function were superior with stereotactic conformal radiotherapy (SCRT) compared with conventional radiotherapy (RT) among young patients with benign or low-grade brain tumors, according to a study published in JAMA Oncology.1
Current evidence for the benefit of SCRT is from small prospective or retrospective studies. This trial aimed to determine whether SCRT could improve functional outcomes without compromising survival among patients with benign or low-grade brain tumors.
This single-center, phase 3 trial (ClinicalTrials.gov Identifier: NCT00517959) randomly assigned 200 patients with residual or progressive benign or low-grade brain tumors to receive 54 Gy in 30 fractions during 6 weeks by high-precision SCRT or conventional RT. Neuropsychologic and neuroendocrine analyses were conducted at baseline, 6 months, and annually thereafter for 4 years.
The median age at baseline was 13 (interquartile range, 9-17 years), with the majority of patients were age 16 or younger.
During the 5-year study, patients treated with SCRT demonstrated superior mean full-scale or global intelligence quotient (IQ) and performance IQ scores compared with patients who received conventional RT.
The SCRT arm also demonstrated lower cumulative incidence of new neuroendocrine dysfunction at 5 years compared with the conventional RT arm (31 vs 51%; P = .01).
Subgroup analyses demonstrated that SCRT particularly benefited patients with a neurological performance scale score of 2 to 3, supratentorial tumors, and patients age 16 or younger.
The 5-year overall survival was similar between the arms, with rates of 86% in the SCRT arm compared with 91% in the conventional RT arm (P = .54). The 5-year tumor control rate was 93% (95% CI, 84-98%) and 92% (95% CI, 83-96%) in the SCRT and conventional RT arms, respectively.
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According to the authors, these data “provide a high level of evidence in favor of SCRT over conventional RT in young patients with brain tumors, improving their functional outcomes with maintenance of excellent long-term tumor control.”
- Jalali R, Gupta T, Goda JS, et al. Efficacy of stereotactic conformal radiotherapy vs conventional radiotherapy on benign and low-grade brain tumors. A randomized clinical trial. JAMA Oncol. 2017 Jun 1. doi: 10.1001/jamaoncol.2017.0997 [Epub ahead of print]