Adjuvant Whole-Brain Radiotherapy Versus Observation After Radiosurgery or Surgical Resection of One to Three Cerebral Metastases: Results of the EORTC 22952-26001 Study
Martin Kocher,Riccardo Soffietti,Ufuk Abacioglu,Salvador Villà,François Fauchon,Brigitta G. Baumert,L. Fariselli,Tzahala Tzuk-Shina,Rolf-Dieter Kortmann,Christian Carrie,Mohamed Ben Hassel,Mauri Kouri,Egils Valeinis,Dirk van den Berge,Sandra Collette,Laurence Collette,Rolf-Peter Mueller +16 more
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After radiosurgery or surgery of a limited number of brain metastases, adjuvant WBRT reduces intracranial relapses and neurologic deaths but fails to improve the duration of functional independence and overall survival.Abstract:
Purpose This European Organisation for Research and Treatment of Cancer phase III trial assesses whether adjuvant whole-brain radiotherapy (WBRT) increases the duration of functional independence after surgery or radiosurgery of brain metastases. Patients and Methods Patients with one to three brain metastases of solid tumors (small-cell lung cancer excluded) with stable systemic disease or asymptomatic primary tumors and WHO performance status (PS) of 0 to 2 were treated with complete surgery or radiosurgery and randomly assigned to adjuvant WBRT (30 Gy in 10 fractions) or observation (OBS). The primary end point was time to WHO PS deterioration to more than 2. Results Of 359 patients, 199 underwent radiosurgery, and 160 underwent surgery. In the radiosurgery group, 100 patients were allocated to OBS, and 99 were allocated to WBRT. After surgery, 79 patients were allocated to OBS, and 81 were allocated to adjuvant WBRT. The median time to WHO PS more than 2 was 10.0 months (95% CI, 8.1 to 11.7 months) after OBS and 9.5 months (95% CI, 7.8 to 11.9 months) after WBRT (P .71). Overall survival was similar in the WBRT and OBS arms (median, 10.9 v 10.7 months, respectively; P .89). WBRT reduced the 2-year relapse rate both at initial sites (surgery: 59% to 27%, P .001; radiosurgery: 31% to 19%, P .040) and at new sites (surgery: 42% to 23%, P .008; radiosurgery: 48% to 33%, P .023). Salvage therapies were used more frequently after OBS than after WBRT. Intracranial progression caused death in 78 (44%) of 179 patients in the OBS arm and in 50 (28%) of 180 patients in the WBRT arm. Conclusion After radiosurgery or surgery of a limited number of brain metastases, adjuvant WBRT reduces intracranial relapses and neurologic deaths but fails to improve the duration of functional independence and overall survival. J Clin Oncol 29:134-141. © 2010 by American Society of Clinical Oncologyread more
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Effect of Radiosurgery Alone vs Radiosurgery With Whole Brain Radiation Therapy on Cognitive Function in Patients With 1 to 3 Brain Metastases: A Randomized Clinical Trial
Paul D. Brown,Kurt A. Jaeckle,Karla V. Ballman,Elana Farace,Jane H. Cerhan,S. Keith Anderson,Xiomara W. Carrero,Fred G. Barker,Richard L. Deming,Stuart H. Burri,Cynthia Ménard,Cynthia Ménard,Caroline Chung,Volker W. Stieber,Bruce E. Pollock,Evanthia Galanis,Jan C. Buckner,Anthony L. Asher +17 more
TL;DR: Among patients with 1 to 3 brain metastases, the use of SRS alone, compared with SRS combined with WBRT, resulted in less cognitive deterioration at 3 months, and in the absence of a difference in overall survival, these findings suggest that.
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