Radiosurgery Saves Brain Function in Patients Where Cancer’s Spread to Multiple Parts of Their Brain

"In patients with three or fewer brain metastases, radiosurgery is preferred over whole brain radiotherapy because whole brain treatment results in a greater memory dysfunction," Christina Kehl Cramer, MD, tells SurvivorNet. "But, in patients with many brain metastases, it's less clear whether radiosurgery or whole brain radiotherapy is the better treatment."  Cramer is a radiation oncologist who specializes in brain tumors at Wake Forest Baptist Health in Winston-Salem, NC.

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The study presented this week at the annual meeting of the American Society for Radiation Oncology (ASTRO) found that the more targeted radiosurgery was just as effective as whole-brain radiation with far less damaging effects on memory and thinking skills.

"This is an important study that implies that sparing normal brain tissue by using radiosurgery rather than whole brain radiotherapy is advantageous to patients even if they have larger number of metastases," Cramer says.

Radiation vs Radiosurgery: What's the Difference?

Like the name describes, in whole-brain radiation, a radiation oncologist directs radiation at your whole brain to get rid of cancer cells that have spread there from other parts of the body. This type of treatment can wipe out even microscopic tumors that your doctors can't see on brain scans. But, it can damage plenty of healthy brain tissue, too. Up to six months or even a couple years after treatment, you can have side effects from this treatment including memory loss and poor brain function.

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Stereotactic radiosurgery, on the other hand, uses precisely focused radiation beams to zero in on the tumor itself and spare the surrounding brain tissue. Radiosurgery brings some of the same potential temporary side effects that whole brain radiation does, including feeling very tired, brain swelling, and redness and pain on your scalp. But, with radiosurgery, you don't run the risk of memory and thinking problems down the line.

"It's important for patients to realize that memory function is a critical quality of life consideration when they are discussing treatment options with their doctors," Cramer says.

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This more precise option is the treatment of choice for people who have no more than three brain metastases. But, there hasn't been a lot of research to show whether it's effective enough for people with many metastases.

Radiosurgery May Now Be Used More

In this new study, researchers compared the effects of radiosurgery to those of whole brain radiation in people who had four to 15 brain metastases. Doctors then kept track of the patients for six months after treatment to see if they had any changes in memory and brain function.

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Patients who got radiosurgery had the same overall survival rates as the ones who received whole brain treatment without at the cognitive side effects. At one, four and six months after treatment, the ones in the radiosurgery group had better thinking skills than the others.

"I suspect that around the country, we will continue to see increased utilization of radiosurgery instead of whole brain treatment as a result of this study," Cramer says.

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