Raadpleeg ook de literatuurlijst niet-toxische middelen bij bestraling van arts-biolkoog drs. Engelbert Valstar

19 januari 2019: Bron: Clinical Breast Cancer

Gerichte bestraling - Stereo Tactische Bestraling (Gamma Knife) voor uitzaaiingen in het hoofd en hersenen vanuit borstkanker geeft betere overall overleving (statistisch significant) en betere kwaliteit van leven in vergelijking met hele hoofd bestraling (WBRT). Dat blijkt uit een langjarige studie op basis van de gegevens uit de database van het Amerikaanse NCI.

Wat ook opvalt is dat in Amerika niet iedereen Stereo Tactische Bestraling wordt aangeboden en is sterk afhankelijk van inkomen en waar iemand woont. Nu is dat in Amerika niet heel vreemd want daar is de gezondheidszorg anders georganiseerd dan hier in nederland. Maar ook hier in Nederland weet ik uit ervaringen van patiënten waar ik contact mee heb dat er soms behoorlijk selectief wordt geselecteerd of iemand een optimale behandeling krijgt ja of nee. Het ego van de behandelend arts speelt m.i. heel vaak een rol of iemand een optimale behandeling krijgt of ook doorgestuurd wordt naar een ander ziekenhuis voor een second opinion ja of nee. Ook financiële motieven spelen best wel een rol vermoed ik.

modelC.gif (7559 bytes) Source: Gamma Knife About Cancer

De studie van het NCI is uitgevoerd en gebaseerd op de gegevens uit de Amerikaanse Nationale Kanker Databank. De onderzoekers concentreerden zich op twee hoofddoelen:

1) patiënten met uitzaaingen van borstkanker in het hoofd en hersenen die tot een bevolkingsgroep horen met bv. geen verzekering en / of weinig inkomen, hebben mogelijk geen toegang tot of krijgen niet de meer geavanceerde behandelingsopties aangeboden, zoals stereotactische radiotherapie, en zijn dus verplicht om volledige hoofdbestraling te nemen. Als ze dat al krijgen.

2) patiënten met uitzaaingen van borstkanker in het hoofd en hersenen willen zelf meestal gerichte therapieën, inclusief gerichte bestralingstherapie, zodat alleen die delen van de hersenen waarvan bekend is dat er uitgezaaide kankertumoren zitten, bestraald worden.

(Borst-) kankerpatiënten zijn vaak bang om uitzaaiingen naar hun hersenen te krijgen (de grootste angst is dat er uitzaaiingen in de hersenstam ontstaan) en zijn ook bang dat ze, eenmaal gediagnosticeerd, een volledige hoofd / hersenbestraling moeten ondergaan, wat grote invloed kan hebben op hun cognitieve functies (denken en concentratie enz.) en hun lichamelijk functioneren kan veranderen.

Zonder een behandeling zijn kankerpatiënten echter ook bang dat ze te maken krijgen met meer epileptische aanvallen, meer cognitieve stoornissen omdat de kanker zal blijven groeien en ze daardoor ook een kortere levensduur zullen hebben. En patienten gaan vaak akkoord met wat de behandelend arts voorstelt. Wat niet altijd dus de optimale behandeling hoeft te zijn. Uit deze studie blijkt dat Stereo Tactische Bestraling veel betere overall overleving dan hele hoofd bestraling geeft met minder chronische bijwerkingen en daardoor ook betere kwaliteit van leven.

De belangrijkste conclusies uit deze studie waren:

In this study, patients with brain metastases from primary breast cancer who were treated with radiation were identified from the National Cancer Data Base to assess patterns of care and survival based on treatment with whole-brain radiation therapy (WBRT) or stereotactic radiosurgery (SRS). Income, insurance status, and treatment setting were significantly different across treatment groups. Significantly more patients received SRS in the second half of the study time period. Median survival was significantly longer in patients treated with SRS compared with those who received WBRT.
There are socioeconomic differences between patients selected for WBRT and SRS, and the study findings highlight the need for less toxic treatments in this patient population.

Het studierapport: Stereotactic Radiosurgery Versus Whole Brain Radiation Therapy: A Propensity Score Analysis and Predictors of Care for Patients With Brain Metastases From Breast Cancer is tegen betaling in te zien. Het abstract staat hieronder

Een andere studie vorig jaar gepubliceerd gaf ook aan dat hersenuitzaaiingen vanuit alle vormen van kanker beter Stereo Tactisch kunnen worden bestraald dan via hele hoofd bestraling:

Targeted radiosurgery better than whole-brain radiation for treating brain tumors

Study shows effectiveness of radiosurgery in controlling spread of brain cancer after surgery

Date:: February 16, 2017
Source:: University of Missouri-Columbia
Summary:: Tumors that originate in other organs of the body and spread to the brain are known as metastatic brain tumors. According to the American Brain Tumor Association, this tumor type is the most common in adults, affecting as many as 300,000 people each year. Researchers compared two common postsurgical therapies for metastatic brain tumors and found that stereotactic radiosurgery can provide better outcomes for patients compared to whole-brain radiation.

Hier het abstract van de NCI studie gepubliceerd in Clinical Breast Cancer, daaronder die van de andere studie:

DOI: https://doi.org/10.1016/j.clbc.2018.11.001

Stereotactic Radiosurgery Versus Whole Brain Radiation Therapy: A Propensity Score Analysis and Predictors of Care for Patients With Brain Metastases From Breast Cancer

Walker Mainwaring

John Bowers

Ngoc Pham

Todd Pezzi

Mihir Shukla

Mark Bonnen

Michelle Ludwig

Correspondence information about the author Michelle Ludwig

Email the author Michelle Ludwig

Abstract

Background

Metastases to the brain occur in 10%-16% of patients with breast cancer, with incidence reportedly increasing. Historically, brain metastases (BM) have been treated with whole-brain radiation therapy (WBRT), but stereotactic radiosurgery (SRS) is an increasingly favored treatment option. In this study we used a population-level database to compare patterns of care and survival between WBRT and SRS for BM from breast cancer.

Materials and Methods

The National Cancer Database was used to select patients treated with radiation for BM from primary breast cancer. Groups were classified on the basis of the modality of radiation delivered to the brain and compared across several demographic factors. A Kaplan–Meier survival curve and Cox multivariate analysis were used to compare overall survival. A matched analysis using propensity scores was used to further reduce confounders and compare survival.

Results

The treatment groups were significantly different across several socioeconomic variables including income, insurance status, and treatment setting. The percentage of patients who received SRS increased dramatically in the second half of the analyzed time period (P < .001). Unadjusted median survival was significantly longer for patients who received SRS versus those who received WBRT (P < .001). This finding persisted after propensity score-matching.

Conclusion

Receipt of SRS was associated with different socioeconomic variables and longer overall survival compared with WBRT, highlighting the need for less toxic treatment for patients who are now living longer. The results revealed important socioeconomic differences between patients selected for SRS versus WBRT and emphasizes disparities in access to modern radiation techniques across the United States.

researchers compared two common postsurgical therapies for metastatic brain tumors and found that stereotactic radiosurgery can provide better outcomes for patients compared to whole-brain radiation.

Targeted radiosurgery better than whole-brain radiation for treating brain tumors

Study shows effectiveness of radiosurgery in controlling spread of brain cancer after surgery

Date:

February 16, 2017

Source:

University of Missouri-Columbia

Summary:

Tumors that originate in other organs of the body and spread to the brain are known as metastatic brain tumors. According to the American Brain Tumor Association, this tumor type is the most common in adults, affecting as many as 300,000 people each year. Researchers compared two common postsurgical therapies for metastatic brain tumors and found that stereotactic radiosurgery can provide better outcomes for patients compared to whole-brain radiation.

Tumors that originate in other organs of the body and spread to the brain are known as metastatic brain tumors. According to the American Brain Tumor Association, this type of tumor is the most common in adults, affecting as many as 300,000 people each year. University of Missouri School of Medicine researchers compared two common postsurgical therapies for metastatic brain tumors and found that stereotactic radiosurgery can provide better outcomes for patients compared to whole-brain radiation.

During whole-brain radiation therapy, beams of radiation cover the entire brain. Because it treats the whole brain, the therapy is thought to control the spread of tumors by treating both identifiable and hidden cancerous cells. However, whole-brain radiation has been associated with a decline in cognitive functions that can negatively affect a patient's quality of life.

In stereotactic radiosurgery, radiation is delivered to more precise areas of the brain. Because it is a targeted therapy, less collateral damage occurs to healthy brain tissue. As a result, patients experience less cognitive decline when compared to whole-brain radiation, and experience a higher quality of life.

"Although radiosurgery has been shown to be an effective post-surgical treatment for metastatic brain tumors, previous studies did not compare patient outcomes from a single hospital over the same period of time," said N. Scott Litofsky, M.D., chief of the Division of Neurological Surgery at the MU School of Medicine and senior author of the study. "Our study is one of the first to directly compare outcomes of patients treated at the same hospital during a set period of time. Ultimately, our findings reinforce the use of radiosurgery over whole-brain radiation."

Under Litofsky's mentorship, Kristen Scheitler-Ring, a medical student doing a pathology fellowship at the MU School of Medicine, studied the outcomes of patients treated at MU Health Care from 2010 to 2014. After undergoing brain surgery to remove a metastatic tumor, 46 patients received whole-brain radiation, while 37 patients received radiosurgery. The researchers found that radiosurgery controlled the spread of the cancerous cells as effectively as whole-brain radiation; patients who received radiosurgery experienced less cognitive decline compared to those who received whole-brain radiation. Additionally, the median survival rate for patients who received radiosurgery was 440 days, compared to 202 days for patients who received whole-brain radiation.

"For patients with metastatic cancer of the brain, the importance of surviving for a longer period of time cannot be overstated," Litofsky said. "In our practice, we now treat patients almost exclusively with radiosurgery following their surgery. Although this therapy does cost more, results often can be achieved in one to three visits compared to 10 to 12 visits for whole-brain radiation. With these considerations, we strongly suggest physicians consider radiosurgery as an initial radiation treatment after surgery."

Story Source:

Materials provided by University of Missouri-Columbia. Note: Content may be edited for style and length.

Journal Reference:

Kristen Scheitler-Ring, Bin Ge, Greg Petroski, Gregory Biedermann, N. Scott Litofsky. Radiosurgery to the Postoperative Tumor Bed for Metastatic Carcinoma Versus Whole Brain Radiation After Surgery. Cureus, 2016; DOI: 10.7759/cureus.88
University of Missouri-Columbia. "Targeted radiosurgery better than whole-brain radiation for treating brain tumors: Study shows effectiveness of radiosurgery in controlling spread of brain cancer after surgery." ScienceDaily. ScienceDaily, 16 February 2017. <www.sciencedaily.com/releases/2017/02/170216130335.htm>.

borstkanker, uitzaaingen in hoofd en hersenen, Stereo Tactische Bestraling, SRS, hele hoofd bestraling, WBRT, radiotherapie, overall overleving, kwaliteit van leven, bijwerkingen.