Multicenter phase 3 trial of stereotactic radiation versus hippocampal-avoidance whole brain radiation for brain metastases

Brain metastases are common in patients with cancer, and radiation is often used for management, Among patients with more than 4 brain metastases, the effects of stereotactic radiation targeting only individual tumors, compared with hippocampal avoidance whole brain radiation (HA-WBRT) remain unknown. A phase 3 trial at 4 US centers compared stereotactic radiation versus HA-WBRT in patients with 5 to 20 brain metastases (median number: 14). In this randomized clinical trial of 196 patients, mean composite MD Anderson Symptom Inventory-Brain Tumor Score (average of symptom severity and interference after baseline minus baseline; score range -10 to 10; -10=best) was -0.32 for stereotactic radiation and 0.74 for HA-WBRT (p<0.001). The authors conclude that compared with HA-WBRT, stereotactic radiation improved symptoms and interference, key components of quality of life, in patients with 5 to 20 brain metastases.