IF THERE ARE MANY METASTASES IN THE BRAIN, IS TARGETED RADIATION THERAPY POSSIBLE?

Sometimes it is not possible to immediately deliver highly precise radiation to individual tumor foci in a patient with brain metastases. The reason is that there are too many lesions or they are too large. But what if the situation changes during the course of treatment?

This is exactly the possibility being studied by specialists at the P. Hertsen Moscow Oncology Research Institute — a branch of the National Medical Research Radiological Centre of the Ministry of Health of Russian Federation. It concerns adaptive radiotherapy.

The principle is as follows: first, the patient undergoes whole‑brain radiation therapy. Then, a follow‑up MRI is performed to assess how the metastases have changed — whether they have shrunk, whether their location has shifted, and whether the edema in the surrounding tissues has decreased. If the results allow it, the doctors create a new treatment plan and deliver additional targeted radiation to the remaining lesions.

Why is this important? This approach may open up the possibility of local treatment for patients who were not initially suitable candidates for it. The study results were presented by Sergei Medvedev, MD, PhD, leading researcher at the Department of Radiation Therapy at the P. Hertsen Moscow Oncology Research Institute.

Fifty patients received adaptive radiotherapy. Another 50 were included in the comparison group and underwent stereotactic radiation therapy. In both groups, local control was 94 %. This means that in most patients, the growth of the irradiated tumor foci was suppressed during the follow‑up period. At the same time, in the adaptive therapy group, doctors were able to target a larger number of metastases on average.

The study is ongoing. Its main prospect is to expand the possibilities of high‑precision radiation therapy for patients with complex metastatic brain disease, while maintaining a focus on treatment safety and quality of life.