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Original Investigation
June 1, 2017

Efficacy of Stereotactic Conformal Radiotherapy vs Conventional Radiotherapy on Benign and Low-Grade Brain TumorsA Randomized Clinical Trial

Author Affiliations
  • 1Neuro-Oncology Disease Management Group, Tata Memorial Centre, Mumbai, India
  • 2Departments of Clinical Psychology and Psychiatry, Tata Memorial Centre, Mumbai, India
  • 3Department of Endocrinology, King Edward Memorial Hospital, Mumbai, India
  • 4Department of Biostatistics, Advanced Centre for Treatment, Research and Education in Cancer, Tata Memorial Centre, Mumbai, India
JAMA Oncol. Published online June 1, 2017. doi:10.1001/jamaoncol.2017.0997
Key Points

Question  Radiotherapy continues to evolve in techniques and precision of delivery, and because randomized clinical trials in radiotherapy are challenging to perform, newer radiotherapy techniques are incorporated into clinical practice—including for benign brain tumors and low grade gliomas—without always being supported by level-1 evidence.

Findings  This randomized clinical trial evaluating the efficacy of stereotactic conformal radiotherapy compared with conventional radiotherapy was designed to address the long-term clinically relevant end points in survivors of brain tumors.

Meaning  We provide high level of evidence in favor of highly conformal radiotherapy achieving significantly superior long-term functional neurocognitive and neuroendocrine outcome.

Abstract

Importance  Evidence for application of stereotactic and other conformal radiotherapy techniques in treating brain tumors is largely based on data derived from dosimetric, retrospective, or small prospective studies. Therefore, we conducted a randomized clinical trial of stereotactic conformal radiotherapy (SCRT) compared with conventional radiotherapy (ConvRT) evaluating clinically meaningful end points.

Objective  To compare neurocognitive and endocrine functional outcomes and survival at 5 years in young patients with residual and/or progressive benign or low-grade brain tumors treated with SCRT and ConvRT techniques.

Design, Setting, and Participants  This phase 3 randomized clinical trial enrolled 200 young patients (ages 3-25 years) with residual or progressive benign or low-grade brain tumors at a single center between April 2001 to March 2012. Patients were randomly allocated (1:1) to either SCRT (n = 104) or ConvRT (n = 96) arms.

Interventions  Patients were randomly assigned to either high-precision SCRT or ConvRT to a dose of 54 Gy in 30 fractions over 6 weeks.

Main Outcomes and Measures  Detailed neuropsychological and neuroendocrine assessments were performed at preradiotherapy baseline, at 6 months, and annually thereafter until 5 years on longitudinal follow-up. Change in these functional parameters was compared between the 2 arms as the primary end point and overall survival (OS) as the secondary end point.

Results  In total, 200 young patients (median [interquartile range] age, 13 [9-17] years; 133 males and 67 females) were enrolled. Mean full-scale or global intelligence quotient (IQ) and performance IQ scores over a period of 5 years were significantly superior in patients treated with SCRT compared with those treated with ConvRT (difference in slope = 1.48; P = .04 vs difference in slope = 1.64; P = .046, respectively). Cumulative incidence of developing new neuroendocrine dysfunction at 5 years was significantly lower in patients treated with SCRT compared with ConvRT (31% vs 51%; P = .01) while developing a new neuroendocrine axis dysfunction in patients with preexisting dysfunction in at least 1 axis at baseline was also significantly lower in the SCRT arm compared with the ConvRT arm (29% vs 52%; P = .02). Five-year OS in SCRT and ConvRT arms was 86% and 91%, respectively (P = .54).

Conclusions and Relevance  In young patients with residual and/or progressive benign or low-grade brain tumors requiring radiotherapy for long-term tumor control, SCRT compared with ConvRT achieves superior neurocognitive and neuroendocrine functional outcomes over 5 years without compromising survival.

Trial Registration  clinicaltrials.gov Identifier: NCT00517959

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