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Whole brain radiotherapy with radiosensitizer for brain metastases.

Viani GA, Manta GB, Fonseca EC, De Fendi LI, Afonso SL, Stefano EJ - J. Exp. Clin. Cancer Res. (2009)

Bottom Line: Pooled results from this 8 RCTs of WBRT with radiosensitizer have not shown a meaningful improvement on overall survival compared to WBRT alone OR = 1.03 (95% CI0.84-1.25, p = 0.77).Also, there was no difference in local brain tumor response OR = 0.8(95% CI 0.5 - 1.03) and brain tumor progression (OR = 1.11, 95% CI 0.9 - 1.3) when the two arms were compared.Our data show that WBRT with the following radiosentizers (ionidamine, metronidazole, misonodazole, motexafin gadolinium, BUdr, efaproxiral, thalidomide), have not improved significatively the overall survival, local control and tumor response compared to WBRT alone for brain metastases.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiation Oncology at Marilia Medicine School, São Paulo, Brazil. gusviani@gmail.com

ABSTRACT

Purpose: To study the efficacy of whole brain radiotherapy (WBRT) with radiosensitizer in comparison with WBRT alone for patients with brain metastases in terms of overall survival, disease progression, response to treatment and adverse effects of treatment.

Methods: A meta-analysis of randomized controlled trials (RCT) was performed in order to compare WBRT with radiosensitizer for brain metastases and WBRT alone. The MEDLINE, EMBASE, LILACS, and Cochrane Library databases, in addition to Trial registers, bibliographic databases, and recent issues of relevant journals were researched. Significant reports were reviewed by two reviewers independently.

Results: A total of 8 RCTs, yielding 2317 patients were analyzed. Pooled results from this 8 RCTs of WBRT with radiosensitizer have not shown a meaningful improvement on overall survival compared to WBRT alone OR = 1.03 (95% CI0.84-1.25, p = 0.77). Also, there was no difference in local brain tumor response OR = 0.8(95% CI 0.5 - 1.03) and brain tumor progression (OR = 1.11, 95% CI 0.9 - 1.3) when the two arms were compared.

Conclusion: Our data show that WBRT with the following radiosentizers (ionidamine, metronidazole, misonodazole, motexafin gadolinium, BUdr, efaproxiral, thalidomide), have not improved significatively the overall survival, local control and tumor response compared to WBRT alone for brain metastases. However, 2 of them, motexafin- gadolinium and efaproxiral have been shown in recent publications (lung and breast) to have positive action in lung and breast carcinoma brain metastases in association with WBRT.

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CNS progression in the trial included in this meta-analysis comparing WBRT with radiosensitizer to WBRT alone.
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Figure 4: CNS progression in the trial included in this meta-analysis comparing WBRT with radiosensitizer to WBRT alone.

Mentions: Four studies [19,20,22,25] had reported CNS progression data (three published and one in abstract form), 1099 patients were included in the analysis. There were no more CNS progression in WBRT alone (150/551 = 27.2%) compared to WBRT with radiosensitizer (135/548 = 24.6%). The likelihood of CNS progression was 1.1-fold higher (95% CI 0.8 – 1.4) in WBRT arms. Test for heterogeneity was not significant with p value of 0.15, as is in the figure 4.


Whole brain radiotherapy with radiosensitizer for brain metastases.

Viani GA, Manta GB, Fonseca EC, De Fendi LI, Afonso SL, Stefano EJ - J. Exp. Clin. Cancer Res. (2009)

CNS progression in the trial included in this meta-analysis comparing WBRT with radiosensitizer to WBRT alone.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2648943&req=5

Figure 4: CNS progression in the trial included in this meta-analysis comparing WBRT with radiosensitizer to WBRT alone.
Mentions: Four studies [19,20,22,25] had reported CNS progression data (three published and one in abstract form), 1099 patients were included in the analysis. There were no more CNS progression in WBRT alone (150/551 = 27.2%) compared to WBRT with radiosensitizer (135/548 = 24.6%). The likelihood of CNS progression was 1.1-fold higher (95% CI 0.8 – 1.4) in WBRT arms. Test for heterogeneity was not significant with p value of 0.15, as is in the figure 4.

Bottom Line: Pooled results from this 8 RCTs of WBRT with radiosensitizer have not shown a meaningful improvement on overall survival compared to WBRT alone OR = 1.03 (95% CI0.84-1.25, p = 0.77).Also, there was no difference in local brain tumor response OR = 0.8(95% CI 0.5 - 1.03) and brain tumor progression (OR = 1.11, 95% CI 0.9 - 1.3) when the two arms were compared.Our data show that WBRT with the following radiosentizers (ionidamine, metronidazole, misonodazole, motexafin gadolinium, BUdr, efaproxiral, thalidomide), have not improved significatively the overall survival, local control and tumor response compared to WBRT alone for brain metastases.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Radiation Oncology at Marilia Medicine School, São Paulo, Brazil. gusviani@gmail.com

ABSTRACT

Purpose: To study the efficacy of whole brain radiotherapy (WBRT) with radiosensitizer in comparison with WBRT alone for patients with brain metastases in terms of overall survival, disease progression, response to treatment and adverse effects of treatment.

Methods: A meta-analysis of randomized controlled trials (RCT) was performed in order to compare WBRT with radiosensitizer for brain metastases and WBRT alone. The MEDLINE, EMBASE, LILACS, and Cochrane Library databases, in addition to Trial registers, bibliographic databases, and recent issues of relevant journals were researched. Significant reports were reviewed by two reviewers independently.

Results: A total of 8 RCTs, yielding 2317 patients were analyzed. Pooled results from this 8 RCTs of WBRT with radiosensitizer have not shown a meaningful improvement on overall survival compared to WBRT alone OR = 1.03 (95% CI0.84-1.25, p = 0.77). Also, there was no difference in local brain tumor response OR = 0.8(95% CI 0.5 - 1.03) and brain tumor progression (OR = 1.11, 95% CI 0.9 - 1.3) when the two arms were compared.

Conclusion: Our data show that WBRT with the following radiosentizers (ionidamine, metronidazole, misonodazole, motexafin gadolinium, BUdr, efaproxiral, thalidomide), have not improved significatively the overall survival, local control and tumor response compared to WBRT alone for brain metastases. However, 2 of them, motexafin- gadolinium and efaproxiral have been shown in recent publications (lung and breast) to have positive action in lung and breast carcinoma brain metastases in association with WBRT.

Show MeSH
Related in: MedlinePlus