Not Just Peanuts

Even though whole brain radiation after local therapy doesn’t improve survival, it reduces the rate of developing new brain mets--especially if there isn’t a good systemic therapy option. Well, this randomized trial came to different conclusions. It’s one of the few brain mets trials to focus on a specific histology: melanoma. Recruiting during, but mostly before, the transition to BRAF-inhibition and immune checkpoint inhibitors (ICI), this trial randomized patients who received local therapy for limited (1-3) melanoma brain mets to no further therapy or whole brain radiation (WBRT). It was a fairly large trial (215 patients), yet there was no significant improvement in the rate of distant intracranial failure 12 months after treatment with WBRT (42%) versus without (50%). | Hong, J Clin Oncol 2019