A randomized trial to assess the efficacy of surgery in addition to radiotherapy in patients with a single cerebral metastasis
Arlan H. Mintz,John R. W. Kestle,Michel P. Rathbone,Laurie E. Gaspar,Herman Hugenholtz,Barbara Fisher,Graeme Duncan,Peter Skingley,Gary Foster,Mark Levine +9 more
TLDR
This data indicates that the addition of surgical extirpation prior to radiation therapy increased survival, neurologic function, and quality of life compared with radiation alone in patients with a single brain metastasis.Abstract:
BACKGROUND
Cerebral metastasis is a common oncologic problem that occurs in 15–30% of cancer patients; approximately half such metastases are single. Previous retrospective studies and two randomized trials reported that the addition of surgical extirpation prior to radiation therapy increased survival, neurologic function, and quality of life compared with radiation alone in patients with a single brain metastasis.
METHODS
A randomized controlled trial was conducted in which patients with a single brain metastasis were allocated to undergo radiation alone or surgery plus radiation. Radiation consisted of 3000 centigray to the whole brain in 10 fractions.
RESULTS
Forty-three patients received radiation alone and 41 patients surgery plus radiation. All but two of the study patients died. No difference in survival was detected between the groups; the median survival for the radiation group was 6.3 months (95% confidence interval, 3–11.4) compared with 5.6 months for the surgery plus radiation group (95% confidence interval, 3.9–7.2) (P = 0.24). Most patients died within the first year (69.8% in the radiation arm vs. 87.8% in the surgery plus radiation arm). There were no significant differences in the 30-day mortality, morbidity, or causes of death. Extracranial metastases was an important predictor of mortality (relative risk, 2.3). The mean proportion of days that the Karnofsky performance status was; ce70% did not differ between the 2 groups.
CONCLUSIONS
This trial failed to demonstrate that the addition of surgery to radiation therapy improved outcome of patients with a single brain metastasis. Thus, the efficacy of surgery plus radiation compared with radiation alone needs to be addressed by further clinical trials and/or a meta-analysis. Cancer 1996;78:1470-6.read more
Citations
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Metastatic non-small-cell lung cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up †
Silvia Novello,Fabrice Barlesi,Raffaele Califano,Raffaele Califano,Tanja Cufer,Simon Ekman,M. Giaj Levra,Keith M. Kerr,Sanjay Popat,Martin Reck,Suresh Senan,G Simo,Johan Vansteenkiste,Sanne Peters +13 more
TL;DR: The ESMO Guidelines Committee concluded that current state-of-the-art oncology practices in France, Belgium, and the Netherlands are suitable for frontline use and recommend further research into these practices.
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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
David W. Andrews,Charles B. Scott,Paul W. Sperduto,Adam E. Flanders,Laurie E. Gaspar,Michael C. Schell,Maria Werner-Wasik,W. Demas,J. Ryu,Jean-Paul Bahary,Luis Souhami,Marvin Rotman,Minesh P. Mehta,Walter J. Curran +13 more
TL;DR: WBRT and stereotactic radiosurgery should, therefore, be standard treatment for patients with a single unresectable brain metastasis and considered for Patients with two or three brain metastases.
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Stereotactic Radiosurgery Plus Whole-Brain Radiation Therapy vs Stereotactic Radiosurgery Alone for Treatment of Brain Metastases: A Randomized Controlled Trial
Hidefumi Aoyama,Hiroki Shirato,Masao Tago,Keiichi Nakagawa,Tatsuya Toyoda,Kazuo Hatano,M. Kenjyo,Natsuo Oya,Saeko Hirota,Hiroki Shioura,Etsuo Kunieda,Taisuke Inomata,Kazushige Hayakawa,Norio Katoh,Gen Kobashi +14 more
TL;DR: Compared with SRS alone, the use of W BRT plus SRS did not improve survival for patients with 1 to 4 brain metastases, but intracranial relapse occurred considerably more frequently in those who did not receive WBRT.
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Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial.
Roy A. Patchell,Phillip A. Tibbs,William F. Regine,Robert J. Dempsey,Mohammed Mohiuddin,Richard J. Kryscio,William R. Markesbery,Kenneth A. Foon,Byron Young +8 more
TL;DR: Patients with cancer and single metastases to the brain who receive treatment with surgical resection and postoperative radiotherapy have fewer recurrences of cancer in the brain and are less likely to die of neurologic causes than similar patients treated withurgical resection alone.
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Clinical practice guidelines in oncology
William J. Gradishar,Benjamin O. Anderson,Ron Balassanian,Sarah L. Blair,Harold J. Burstein,Amy E. Cyr,Anthony D. Elias,William B. Farrar,Andres Forero,Sharon H. Giordano,Matthew P. Goetz,Lori J. Goldstein,Steven J. Isakoff,Janice A. Lyons,P. Kelly Marcom,Ingrid A. Mayer,Beryl McCormick,Meena S. Moran,Ruth O'Regan,Sameer A. Patel,Lori J. Pierce,Elizabeth C. Reed,Kilian E. Salerno,Lee S. Schwartzberg,Amy Sitapati,Karen L. Smith,Mary Lou Smith,Hatem Soliman,George Somlo,Melinda L. Telli,John H. Ward,Rashmi Kumar,Dorothy A. Shead +32 more
TL;DR: This manuscript focuses on the NCCN Guidelines Panel recommendations for the workup, primary treatment, risk reduction strategies, and surveillance specific to DCIS.
References
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A Randomized Trial of Surgery in the Treatment of Single Metastases to the Brain
Roy A. Patchell,Phillip A. Tibbs,John W. Walsh,Robert J. Dempsey,Yosh Maruyama,Richard J. Kryscio,William R. Markesbery,John S. Macdonald,Byron Young +8 more
TL;DR: It is concluded that patients with cancer and a single metastasis to the brain who receive treatment with surgical resection plus radiotherapy live longer, have fewer recurrences of cancer in the brain, and have a better quality of life than similar patients treated with radiotherapy alone.
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The use of the nitrogen mustards in the palliative treatment of carcinoma. With particular reference to bronchogenic carcinoma
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Measuring the quality of life of cancer patients: a concise QL-index for use by physicians.
Walter O. Spitzer,Walter O. Spitzer,Annette J. Dobson,Annette J. Dobson,Jane Hall,Jane Hall,Esther Chesterman,Esther Chesterman,John Levi,John Levi,Richard Shepherd,Richard Shepherd,Renaldo N. Battista,Renaldo N. Battista,Barry R. Catchlove,Barry R. Catchlove +15 more
TL;DR: The aim has been to provide a new measure that can help physicians assess the relative benefits and risks of various treatments for serious illness and of supportive programs such as palliative care or hospice service.
Journal ArticleDOI
Treatment of single brain metastasis: Radiotherapy alone or combined with neurosurgery
Charles J. Vecht,H. Haaxma-Reiche,Evert M. Noordijk,George W. Padberg,J. H. C. Voormolen,F. H. Hoekstra,J. T. J. Tans,N. Lambooij,J. A. L. Metsaars,A. R. Wattendorff,Ronald Brand,Jo Hermans +11 more
TL;DR: It is coclude that patients with single brain metastasis and stable extracranial tumor activity should be treated with surgical excision and radiotherapy, and that radiotherapy alone appears to be sufficient.
Journal ArticleDOI
The palliation of brain metastases: Final results of the first two studies by the radiation therapy oncology group
B.B. Borgelt,Richard D. Gelber,Simon Kramer,Luther W. Brady,Chu H. Chang,Lawrence W. Davis,Carlos A. Perez,Frank R. Hendrickson +7 more
TL;DR: Five schedules of whole brain irradiation ranging from 4000 rad/4 weeks to 2000 rad/ 1 week have been evaluated in two sequential phase III randomized Radiation Therapy Oncology Group (RTOG I studies) to determine palliative effectiveness in patients with metastatic brain disease.