A matched-pair study comparing whole-brain irradiation alone to radiosurgery or fractionated stereotactic radiotherapy alone in patients irradiated for up to three brain metastases

Dirk Rades, Stefan Janssen, Liesa Dziggel, Oliver Blanck, Amira Bajrovic, Theo Veninga, Steven E Schild, Dirk Rades, Stefan Janssen, Liesa Dziggel, Oliver Blanck, Amira Bajrovic, Theo Veninga, Steven E Schild

Abstract

Background: This matched-pair study was initiated to validate the results of a retrospective study of 186 patients published in 2007 that compared whole-brain irradiation (WBI) alone and radiosurgery (RS) alone for up to three brain metastases.

Methods: One-hundred-fifty-two patients receiving WBI alone for up to three brain metastases were matched with 152 patients treated with RS of fractionated stereotactic radiotherapy (FSRT) alone 1:1 for each of eight factors (age, gender, Eastern Oncology Cooperative Group (ECOG)-performance score, nature of tumor, brain metastases number, extra-cerebral spread, period from cancer detection to irradiation of brain metastases, and recursive partitioning analysis (RPA)-class. Groups were analyzed regarding intracerebral control (IC) and overall survival (OS).

Results: On univariate analysis of IC, type of irradiation did not significantly affect outcomes (p = 0.84). On Cox regression, brain metastases number (p < 0.001), nature of tumor (p < 0.001) and period from cancer detection to irradiation of brain metastases (p = 0.013) were significantly associated with IC. On univariate analysis of OS, type of irradiation showed no significant association with outcomes (p = 0.63). On multivariate analyses, OS was significantly associated with ECOG performance score (p = 0.011), nature of tumor (p = 0.035), brain metastases number (p = 0.048), extra-cerebral spread (p = 0.002) and RPA-class (p < 0.001).

Conclusion: In this matched-pair study, RS/FSRT alone was not superior to WBI alone regarding IC and OS. These results can be considered a revision of the findings from our retrospective previous study without matched-pair design, where RS alone resulted in significantly better IC than WBI alone on multivariate analysis.

Keywords: Intracerebral control; Matched-pair study; Metastases to the brain; Overall survival; Radiosurgery; Whole-brain irradiation.

Figures

Fig. 1
Fig. 1
Comparison of whole-brain irradiation (WBI) alone and stereotactic radiosurgery (RS) or fractionated stereotactic radiotherapy (FSRT) alone with respect to intracerebral control (Kaplan-Meier curves)
Fig. 2
Fig. 2
Comparison of whole-brain irradiation (WBI) alone and stereotactic radiosurgery (RS) or fractionated stereotactic radiotherapy (FSRT) alone with respect to overall survival (Kaplan-Meier curves)

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Source: PubMed

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