Management of brain metastases with stereotactic radiosurgery alone versus whole brain irradiation alone versus both

Mahmoud M El Gantery, Hoda M Abd El Baky, Hesham A El Hossieny, Mohamed Mahmoud, Osama Youssef, Mahmoud M El Gantery, Hoda M Abd El Baky, Hesham A El Hossieny, Mohamed Mahmoud, Osama Youssef

Abstract

Introduction: This prospective randomized study aimed to evaluate the role of WBRT + SRS compared to SRS alone and to WBRT alone in improvement of overall survival, brain local control and neurologic manifestations.

Patients and methods: The trial included 60 patients with 1 to 3 brain metastases treated at the Radiotherapy Department, National Cancer Institute. 21 patients received WBRT + SRS, 18 patients received SRS alone and 21 patients received WBRT alone.

Results: Median local control was significantly better for WBRT + SRS compared to SRS alone & WBRT alone (10 vs 6 vs 5 months, respectively, P = 0.04). There was non significant survival benefit for WBRT + SRS compared to SRS alone & WBRT alone. Survival was significantly better for patients with controlled primary tumor who received WBRT + SRS compared to SRS alone & WBRT alone (median survival was 12 vs 5.5 vs 8 months, respectively. P = 0.027). Regardless of the treatment group, median survival and median local control were highly significantly better for single brain site involvement compared to multiple brain sites involvement (P = 0.003 & P = 0.001, respectively), and median brain local control was significantly better for single lesion compared to multiple lesions (P = 0.05).

Conclusions: WBRT + SRS is an effective, safe tool in treatment of patients with 1 to 3 brain metastses improving the brain local control, but further studies with larger number of patients is recommended.

Figures

Figure 1
Figure 1
Distribution of patients in studied arms according to no. of brain lesions.
Figure 2
Figure 2
Local control of the 3 treatments groups.
Figure 3
Figure 3
The LC according to number of brain lesions.
Figure 4
Figure 4
The LC according to number of brain sites involved.
Figure 5
Figure 5
Overall survival for all patients.
Figure 6
Figure 6
Overall survival for each treatment group.
Figure 7
Figure 7
Overall survival according to number of brain sites involved.

References

    1. Posner JB. Management of brain metastases. Rev Neurol (Paris) 1992;148(6–7):477–487.
    1. Wen PY, Loeffler JS. Management of brain metastases. Oncology (Williston Park) 1999;13(7):941–954. 957–962, 969.
    1. Loeffler JS, Patchell RA, Sawaya R. In: Cancer: Principles and Practice of Oncology. 5. Devita VT, Hellman S, Rosenberg SA, editor. Philadelphia: Lippincott-Raven; 1997. Treatment of metastatic cancer; pp. 2523–2525.
    1. Eichler AF, Loeffler JS. Multidisciplinary management of brain metastases. Onccologist. 2007;12(7):884–898. doi: 10.1634/theoncologist.12-7-884.
    1. Aoyama H, Shirato H, Tago M, Nakagawa K, Toyoda T, Hatano K, Kenjyo M, Oya N, Hirota S, Shioura H, Kunieda E, Inomata T, Hayakawa K, Katoh N, Kobashi G. Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA. 2006;295(21):2483–2491. doi: 10.1001/jama.295.21.2483.
    1. Markesbery WR, Brooks WH, Gupta GD, Young AB. Treatment for patients with cerebral metastases. Arch Neurol. 1978;35(11):754–756. doi: 10.1001/archneur.1978.00500350058012.
    1. Borgelt B, Gelber R, Kramer S, Brady LW, Chang CH, Davis LW, Perez CA, Hendrickson FR. The palliation of brain metastases: final results of the first two studies by the Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys. 1980;6(1):1–9. doi: 10.1016/0360-3016(80)90195-9.
    1. Roos DE. What is the randomised evidence for surgery and stereotactic radiosurgery for patients with solitary (or few) brain metastases? Int J Evid Based Healthc. 2011;9(1):61–66. doi: 10.1111/j.1744-1609.2010.00201.x.
    1. Kondziolka D, Patel A, Lunsford LD, Kassam A, Flickinger JC. Stereotactic radiosurgery plus whole brain radiotherapy versus radiotherapy alone for patients with multiple brain metastases. Int J Radiat Oncol Biol Phys. 1999;45(2):427–434. doi: 10.1016/S0360-3016(99)00198-4.
    1. Trotti A, Byhardt R, Stetz J, Gwede C, Corn B, Fu K, Gunderson L, McCormick B, Morrisintegral M, Rich T, Shipley W, Curran W. 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(1):13–47. doi: 10.1016/S0360-3016(99)00559-3.
    1. Chougule PB, Burton-Williams M, Saris S, Zheng Z, Ponte B, Noren G, Alderson L, Friehs G, Wazer D, Epstein M. Randomized treatment of brain metastasis with gamma knife radiosurgery, whole brain radiotherapy or both. (Abst) Int J Radiat Oncol Biol Phys. 2000;48(3):114. 1 Suppl.
    1. Kocher M, Soffietti R, Abacioglu U, Villà S, Fauchon F, Baumert BG, Fariselli L, Tzuk-Shina T, Kortmann RD, Carrie C, Ben Hassel M, Kouri M, Valeinis E, van den Berge D, Collette S, Collette L, Mueller RP. Adjuvant whole brain radiotherapy versus observation after radiosurgery or surgical resection of 1–3 cerebral metastases: Results of the EORTC 22952–26001 study. J Clin Oncol. 2011;29(2):134–141. doi: 10.1200/JCO.2010.30.1655.
    1. Andrews DW, Scott CB, Sperduto PW, Flanders AE, Gaspar LE, Schell MC, Werner-Wasik M, Demas W, Ryu J, Bahary JP, Souhami L, Rotman M, Mehta MP, Curran WJ Jr. Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: Phase III results of the RTOG 9508 randomised trial. Lancet. 2004;363:1665–1672. doi: 10.1016/S0140-6736(04)16250-8.
    1. Chang EL, Wefel JS, Hess KP, Allen PK, Lang FF, Kornguth DG, Arbuckle RB, Swint JM, Shiu AS, Maor MH, Meyers CA. Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol. 2009;10:1037–1044. doi: 10.1016/S1470-2045(09)70263-3.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する