Whole Brain Radiotherapy (WBRT) is a common palliative treatment for brain metastases (BMs). WBRT traditionally leads to acute epilation and alopecia, affecting patient quality of life (QoL). Volumetric modulated arc therapy hair sparing whole brain radiotherapy (VMAT HSWBRT) may allow hair sparing by reducing the dose to hair follicles. This feasibility study is a sub-study of the ANZMTG 01.07 Whole Brain Radiotherapy following local treatment of intracranial metastases of melanoma (WBRTMel), randomised phase III trial.
The primary hypothesis is that VMAT HSWBRT will spare scalp hair, assessed by cross-section trichometry measurement (CTM) and dermatologist at 4 weeks post treatment, without compromising brain control at 3 months. This technique also allows for simultaneous integrated boost to macroscopic BMs on MRI, negating the need for stereotactic radiosurgery on another machine.
Any patients with BMs from any solid tumour who require WBRT are eligible. The total accrual required is 12 patients, 10 patients with hair worth conserving and 2 bald controls to assess the skin dose delivered. Patients are assessed by a dermatologist and hair density measurements are conducted by CTM. Brain control is assessed at baseline and 3 months post treatment using MRI. QoL is assessed at baseline, 1 month and 3 months post treatment using the Chemotherapy-Induced Alopecia Distress Scale, EORTC QLQ-C15-PAL+4 and Visual Analogue Scale.
The trial is ethics approved, has support of WBRTMel trial management and data safety monitoring committees and is registered on Australian New Zealand Clinical Trials Registry (ACTRN12617000507381). The study is only open at Mater Sydney Hospital, with other VMAT centres interested. Three patients have been recruited since the study opened in February 2017. One patient withdrew as they required urgent cytotoxic therapy during the study period affecting the primary endpoint.
VMAT HSWBRT may be possible and result in benefits to patients in terms of QoL.