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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
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
Department of Neurosurgery, Thomas Jefferson University Hospital,
Philadelphia, PA 19107, USA. david.andrews@jefferson.edu
Background. Brain metastases occur in up to 40% of all
patients with systemic cancer.
We aimed to assess whether stereotactic radiosurgery provided any therapeutic
benefit in a randomised multi-institutional trial directed by the Radiation
Therapy Oncology Group (RTOG).
Methods.
Patients with
one to three newly diagnosed brain metastases were randomly allocated either
whole brain radiation therapy (WBRT) or WBRT followed by stereotactic
radiosurgery boost.
Patients were stratified by number of metastases and status of extracranial
disease.
Primary outcome was survival; secondary outcomes were tumour response and local
rates, overall intracranial recurrence rates, cause of death, and performance
measurements.
Findings.
From January,
1996, to June, 2001, we enrolled 333 patients from 55 participating RTOG
institutions--167 were assigned WBRT and stereotactic radiosurgery and 164 were
allocated WBRT alone.
Univariate analysis showed that there was a survival advantage in the WBRT and
stereotactic radiosurgery group for patients with a single brain metastasis
(median survival time 6.5 vs 4.9 months, p=0.0393).
Patients in the stereotactic surgery group were more likely to have a stable or
improved Karnofsky Performance Status (KPS) score at 6 months' follow-up than
were patients allocated WBRT alone (43% vs 27%, respectively; p=0.03).
By multivariate analysis, survival improved in patients with an RPA class 1
(p<0.0001) or a favourable histological status (p=0.0121).
Interpretation.
WBRT and
stereotactic boost treatment improved functional autonomy (KPS) for all patients
and survival for patients with a single unresectable brain metastasis.
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.
PMID: 15158627 [PubMed - indexed for MEDLINE]
Source: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15158627
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