Advertisement
Research Article| Volume 45, ISSUE 3, P400-404, February 2009

Whole brain radiotherapy plus stereotactic radiosurgery (WBRT+SRS) versus surgery plus whole brain radiotherapy (OP+WBRT) for 1–3 brain metastases: Results of a matched pair analysis

Published:December 08, 2008DOI:https://doi.org/10.1016/j.ejca.2008.10.033

      Abstract

      This study is the first one to compare WBRT + SRS to OP + WBRT for 1–3 brain metastases. Survival (OS), intracerebral control (IC) and local control (LC) of the treated metastases were retrospectively evaluated in 52 patients undergoing WBRT + SRS and in 52 patients undergoing OP + WBRT. Both groups were matched for WBRT schedule, age, gender, performance status, tumour, number of brain metastases, extracerebral metastases, RPA class and interval from tumour diagnosis to WBRT. One-year OS was 56% after WBRT + SRS and 47% after OP + WBRT (p = 0.034). One-year IC was 66% and 50% (p = 0.003). One-year LC was 82% and 66% (p = 0.006). On multivariate analyses, it was found that improved OS was associated with younger age (p = 0.044), no extracerebral metastases (p < 0.001), RPA class 1 (p < 0.001) and longer interval from tumour diagnosis to WBRT (p = 0.001). IC was associated with younger age (p = 0.002) and longer interval (p = 0.004); WBRT + SRS achieved borderline significance (p = 0.052). Improved LC was associated with longer interval (p = 0.017); WBRT + SRS showed a trend (p = 0.09). WBRT + SRS appears at least as effective as OP + WBRT.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Cancer
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Regine W.F.
        • Scott C.
        • Murray K.
        • Curran W.
        Neurocognitive outcome in brain metastases patients treated with accelerated-fractionation vs. accelerated-hyperfractionated radiotherapy: an analysis from Radiation Therapy Oncology Group Study 91-04.
        Int J Radiat Oncol Biol Phys. 2001; 51: 711-717
        • Meyers C.A.
        • Smith J.A.
        • Bezjak A.
        • et al.
        Neurocognitive function and progression in patients with brain metastases treated with whole-brain radiation and motexafin gadolinium: results of a randomized phase III trial.
        J Clin Oncol. 2004; 22: 157-165
        • Aoyama H.
        • Tago M.
        • Kato N.
        • et al.
        Neurocognitive function of patients with brain metastasis who received either whole brain radiotherapy plus stereotactic radiosurgery or radiosurgery alone.
        Int J Radiat Oncol Biol Phys. 2007; 68: 1388-1395
        • Schoggl A.
        • Kitz K.
        • Reddy M.
        • et al.
        Defining the role of stereotactic radiosurgery versus microsurgery in the treatment of single brain metastases.
        Acta Neurochir (Wien). 2000; 142: 621-626
        • O’Neill B.P.
        • Iturria N.J.
        • Link M.J.
        • Pollock B.E.
        • Ballman K.V.
        • O’Fallon J.R.
        A comparison of surgical resection and stereotactic radiosurgery in the treatment of solitary brain metastases.
        Int J Radiat Oncol Biol Phys. 2003; 55: 1169-1176
        • Gaspar L.E.
        • Scott C.
        • Rotman M.
        • et al.
        Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials.
        Int J Radiat Oncol Biol Phys. 1997; 37: 745-751
        • Kaplan E.L.
        • Meier P.
        Non parametric estimation from incomplete observations.
        J Am Stat Assoc. 1958; 53: 457-481
        • Trotti A.
        • Byhardt R.
        • Stetz J.
        • et al.
        Common toxicity criteria: version 2.0. An improved reference for grading the acute effects of cancer treatment: impact on radiotherapy.
        Int J Radiat Oncol Biol Phys. 2000; 47: 13-47
        • Patchell R.A.
        • Tibbs P.A.
        • Regine W.F.
        • et al.
        Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial.
        JAMA. 1998; 280: 1485-1489
        • Smalley S.R.
        • Schray M.F.
        • Laws Jr., E.R.
        • O’Fallon J.R.
        Adjuvant radiation therapy after surgical resection of solitary brain metastasis: association with pattern of failure and survival.
        Int J Radiat Oncol Biol Phys. 1987; 13: 1611-1616
        • Smalley S.R.
        • Laws Jr., E.R.
        • O’Fallon J.R.
        • Shaw E.G.
        • Schray M.F.
        Resection for solitary brain metastasis. Role of adjuvant radiation and prognostic variables in 229 patients.
        J Neurosurg. 1992; 77: 531-540
        • Aoyama H.
        • Shirato H.
        • Tago M.
        • et al.
        Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases. A randomized controlled trial.
        JAMA. 2006; 295: 2483-2491
        • Sneed P.K.
        • Lamborn K.R.
        • Forstner J.M.
        • et al.
        Radiosurgery for brain metastases: is whole brain radiotherapy necessary?.
        Int J Radiat Oncol Biol Phys. 1999; 43: 549-558
        • Varlotto J.M.
        • Flickinger J.C.
        • Niranjan A.
        • Bhatnagar A.
        • Kondziolka D.
        • Lunsford L.D.
        The impact of whole-brain radiation therapy on the long-term control and morbidity of patients surviving more than one year after gamma knife radiosurgery for brain metastases.
        Int J Radiat Oncol Biol Phys. 2005; 62: 1125-1132
        • Khuntia D.
        • Brown P.
        • Li J.
        • Mehta M.P.
        Whole-brain radiotherapy in the management of brain metastasis.
        J Clin Oncol. 2006; 24: 1295-1304