Optimal timing

How to time radiotherapy for brain metastases is a controversial question in oncology circles. A trial at University Hospital Zurich now aims to settle the matter to increase cancer patients’ chances of survival.

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They were small but suspicious changes in his brain. Robert Steiner’s* lung cancer metastasized. Fortunately the metastases could be treated. Thanks to advances in medicine, many cancer patients have significantly longer life expectancy. Even so, the longer they survive, the greater the danger of metastasis. Sometimes these are only discovered after years where there was no more sign of the primary tumor.

With some forms of cancer, metastases are particularly likely to form in the brain. Treating these brain metastases is a big challenge. Neurological surgery to remove them is only an option for a minority of patients. Chemotherapy often has little effect. These days there is also growing use of novel treatments such as immunotherapies and targeted cancer therapies for brain metastases.

By far the most common form of treatment for brain metastases is radiotherapy. But the optimal time to irradiate is one of the most controversial questions in oncology. Should it be done as soon as the brain metastasis is diagnosed, or only once another treatment, for example immunotherapy, has failed to produce results? This matter is especially urgent now that optimal ways are being sought of combining radiotherapy with novel therapies for the primary tumor.

To date there has been no randomized study to determine the optimum timing for irradiating brain metastases. But the question is key to patients’ chances of survival. The Comprehensive Cancer Center Zurich (CCCZ) – the oncology unit at University Hospital Zurich (USZ) – now intends to find an answer with a randomized clinical trial. Alongside USZ, ten other hospitals in Switzerland, Italy, Great Britain and the Netherlands will take part in the trial. Given that the results will find their way into treatment guidelines for patients with brain metastases all over the world, this has the potential to improve the lives of many people. It will make sure more patients like Robert Steiner get optimal treatment. To make this happen, the USZ Foundation is looking for more supporting partners for the project.

*anonymized/symbolic image

80% financed

Dr. Emilie Le Rhun and Prof. Dr. Luca Regli, Department of Neurosurgery, USZ
Prof. Dr. Nicolaus Andratschke and Prof. Dr. Matthias Guckenberger, Department of Radiation Oncology, USZ
PD Dr. Alessandra Curioni and Prof. Dr. Andreas Wicki, Department of Medical Oncology and Haematology, USZ
Prof. Dr. Reinhard Dummer, Department of Dermatology, USZ
Five other university hospitals in Switzerland, Sweden, and Denmark

Baugarten Stiftung
Fondation Chercher et trouver
Giuliana und Giorgio Stefanini Stiftung
Lotte & Adolf Hotz-Sprenger Stiftung
MAIORES STIFTUNG
Peter Bockhoff Stiftung
Sophien-Stiftung zur Förderung der klinischen Krebsforschung
Spendenstiftung Bank Vontobel
Stiftung für angewandte Krebsforschung
Stiftung zur Krebsbekämpfung
Theron Foundation
VSM-Stiftung