From: Subject: JAMA -- Abstract: Stereotactic Radiosurgery Plus Whole-Brain Radiation Therapy vs Stereotactic Radiosurgery Alone for Treatment of Brain Metastases: A Randomized Controlled Trial, June 7, 2006, Aoyama et al. 295 (21): 2483 Date: Wed, 7 Jun 2006 08:37:32 +0200 MIME-Version: 1.0 Content-Type: multipart/related; type="text/html"; boundary="----=_NextPart_000_0000_01C68A0D.9E4640D0" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2900.2869 This is a multi-part message in MIME format. ------=_NextPart_000_0000_01C68A0D.9E4640D0 Content-Type: text/html; charset="Windows-1252" Content-Transfer-Encoding: quoted-printable Content-Location: http://jama.ama-assn.org/cgi/content/abstract/295/21/2483 JAMA -- Abstract: Stereotactic Radiosurgery Plus = Whole-Brain Radiation Therapy vs Stereotactic Radiosurgery Alone for = Treatment of Brain Metastases: A Randomized Controlled Trial, June 7, = 2006, Aoyama et al. 295 (21): 2483

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Stereotactic Radiosurgery = Plus=20 Whole-Brain Radiation Therapy vs Stereotactic Radiosurgery = Alone for=20 Treatment of Brain Metastases

A Randomized Controlled Trial =

Hidefumi Aoyama, MD, PhD; Hiroki = Shirato,=20 MD, PhD; Masao Tago, MD, PhD; = Keiichi=20 Nakagawa, MD, PhD; Tatsuya Toyoda, MD, = PhD;=20 Kazuo Hatano, MD, PhD; Masahiro Kenjyo, = MD,=20 PhD; Natsuo Oya, MD, PhD; Saeko = Hirota,=20 MD, PhD; Hiroki Shioura, MD, PhD; = Etsuo=20 Kunieda, MD, PhD; Taisuke Inomata, MD, = PhD;=20 Kazushige Hayakawa, MD, PhD; Norio Katoh, = MD; Gen Kobashi, MD, PhD

JAMA. 2006;295:2483-2491.

Context  In patients with brain = metastases, it is=20 unclear whether adding up-front whole-brain = radiation=20 therapy (WBRT) to stereotactic radiosurgery (SRS) = has=20 beneficial effects on mortality or neurologic = function=20 compared with SRS alone.

Objective  To determine if WBRT combined with = SRS=20 results in improvements in survival, brain tumor = control,=20 functional preservation rate, and frequency of = neurologic=20 death.

Design, Setting, and Patients  Randomized = controlled=20 trial of 132 patients with 1 to 4 brain = metastases, each=20 less than 3 cm in diameter, enrolled at 11 = hospitals in=20 Japan between October 1999 and December = 2003.

Interventions  Patients were randomly = assigned to=20 receive WBRT plus SRS (65 patients) or SRS alone = (67=20 patients).

Main Outcome Measures  The primary end point = was=20 overall survival; secondary end points were brain = tumor=20 recurrence, salvage brain treatment, functional=20 preservation, toxic effects of radiation, and = cause of=20 death.

Results  The median survival time and the = 1-year=20 actuarial survival rate were 7.5 months and 38.5% = (95%=20 confidence interval, 26.7%-50.3%) in the=20 WBRT + SRS group and 8.0 months and = 28.4% (95%=20 confidence interval, 17.6%-39.2%) for SRS alone=20 (P =3D .42). The 12-month brain tumor = recurrence rate was 46.8% in the = WBRT + SRS=20 group and 76.4% for SRS alone group = (P<.001).=20 Salvage brain treatment was less frequently = required in=20 the WBRT + SRS group (n =3D 10) = than=20 with SRS alone (n =3D 29) (P<.001). = Death was=20 attributed to neurologic causes in 22.8% of patients = in=20 the WBRT + SRS group and in 19.3% of = those=20 treated with SRS alone = (P =3D .64). There=20 were no significant differences in systemic and=20 neurologic functional preservation and toxic = effects of=20 radiation.

Conclusions  Compared with SRS alone, the use = of WBRT=20 plus SRS did not improve survival for patients = with 1 to=20 4 brain metastases, but intracranial relapse = occurred=20 considerably more frequently in those who did not = receive=20 WBRT. Consequently, salvage treatment is = frequently=20 required when up-front WBRT is not used. =

Trial Registration  umin.ac.jp/ctr = Identifier: C000000412=20


Author=20 Affiliations: Departments of Radiology (Drs Aoyama, = Shirato, and=20 Katoh) and Global Health and Epidemiology, Division of = Preventive=20 Medicine (Dr Kobashi), Hokkaido University Graduate School = of=20 Medicine, Sapporo, Japan; Department of Radiology, = University of=20 Tokyo Hospital, Tokyo, Japan (Drs Tago and Nakagawa); = Department of=20 Radiology, Kanto Medical Center NTT EC, Tokyo, Japan (Dr = Toyoda);=20 Department of Radiology, Chiba Cancer Center, Chiba, Japan = (Dr=20 Hatano); Department of Radiology, Hiroshima University = School of=20 Medicine, Hiroshima, Japan (Dr Kenjyo); Department of = Radiology,=20 Kyoto University School of Medicine, Kyoto, Japan (Dr Oya);=20 Department of Radiology, Hyogo Medical Center for Adults, = Akashi,=20 Japan (Dr Hirota); Department of Radiology, Izumisano = General=20 Hospital, Izumisano, Japan (Dr Shioura); Department of = Radiology,=20 Keio University School of Medicine, Tokyo, Japan (Dr = Kunieda);=20 Department of Radiology, Osaka Medical College, Osaka, Japan = (Dr=20 Inomata); Department of Radiology, Kitazato Medical School,=20 Sagamihara, Japan (Dr Hayakawa).


RELATED=20 ARTICLES=20
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This Week in = JAMA
JAMA.=20 2006;295:2445.
FULL=20 TEXT  =20

Radiosurgery and Whole-Brain Radiation Therapy = for Brain=20 Metastases: Either or Both as the Optimal=20 Treatment
Jeffrey Raizer
JAMA.=20 2006;295:2535-2536.
EXTRACT= =20 | FULL=20 TEXT  =20


THIS ARTICLE HAS BEEN CITED BY OTHER = ARTICLES=20
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Radiosurgery and Whole-Brain Radiation = Therapy for=20 Brain Metastases: Either or Both as the Optimal=20 Treatment
Raizer
JAMA=20 2006;295:2535-2536.
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