A phase 2 study of radiosurgery and temozolomide for patients with 1 to 4 brain metastases.

Purpose: To determine if temozolomide reduces the risk of distant brain failure (DBF, metachronous brain metastases) in patients with 1 to 4 brain metastases treated with radiosurgery without whole-brain radiation therapy (WBRT).

Methods And Materials: Twenty-five patients with newly diagnosed brain metastases were enrolled in a single institution phase 2 trial of radiosurgery (15-24 Gy) and adjuvant temozolomide. Temozolomide was continued for a total of 12 cycles unless the patient developed DBF, unacceptable toxicity, or systemic progression requiring other therapy.

Management of brain metastases.

As systemic cancer therapies have improved, the natural history and importance of treating brain metastases continues to evolve. Historically, most patients with brain metastases have been managed with whole brain radiation therapy (WBRT) with surgical resection or radiosurgery added for patients with single or few metastases. Because the potential late toxicity of WBRT is increasingly recognized when systemic tumor is more effectively controlled, there has been increased interest in the use of focal therapies such as radiosurgery with deferred WBRT even for patients with larger numbers of metastases.

Stereotactic body radiation therapy for liver metastases and primary hepatocellular carcinoma: normal tissue tolerances and toxicity.

Background: There is growing interest in stereotactic body radiation therapy (SBRT) as a noninvasive means of treating inoperable hepatic metastases and primary intrahepatic hepatobiliary carcinomas. While initial outcomes are encouraging, the safety of delivering such large, ablative doses is still being studied.

Methods: We compiled all dose-volume constraints from seven prospective trials of liver SBRT and linked them to reported toxicities.

Stage-specific survival differences associated with postoperative radiotherapy for gastrointestinal cancers.

Objective: To study the frequency and effect associated with postoperative radiotherapy (RT) for patients with resected gastrointestinal (GI) cancers.

Materials And Methods: In observational cohort from the Surveillance, Epidemiology, and End Results (SEER) program, a total of 23,049 patients were identified with resected pancreatic, gastric, esophageal, or rectal carcinomas diagnosed from 1988 to 2003. Using a propensity score analysis, survival differences associated with postoperative RT were analyzed.

Adjuvant radiotherapy for pancreatic cancer is associated with a survival benefit primarily in stage IIB patients.

Background: The role of adjuvant radiotherapy (RT) for pancreatic cancer remains controversial despite the completion of three multi-institutional randomized trials. This study examines the survival impact of postoperative RT in a large population-based database.

Methods: Patients with pancreatic cancer diagnosed from 1988 to 2003 were identified in the Surveillance, Epidemiology, and End Results (SEER) database.