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Comparison of stereotactic radiosurgery (SRS) alone and whole brain radiotherapy (WBRT) plus a stereotactic boost (WBRT + SRS) for one to three brain metastases

Vergleich von alleiniger Radiochirurgie (SRS) und Ganzhirnbestrahlung plus stereotaktischem Boost (WBRT + SRS) bei der Behandlung von 1 bis 3 Hirnmetastasen

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Abstract

Background

The best available treatment of patients with one to three brain metastases is still unclear. This study compared the results of stereotactic radiosurgery (SRS) alone and whole brain radiotherapy (WBRT) plus SRS (WBRT + SRS).

Patients and Methods

Survival (OS), intracerebral control (IC), and local control of treated metastases (LC) were retrospectively analyzed in 144 patients receiving SRS alone (n = 93) or WBRT + SRS (n = 51). Eight additional potential prognostic factors were evaluated: age, gender, Eastern Cooperative Oncology Group performance score (ECOG-PS), tumor type, number of brain metastases, extracerebral metastases, recursive partitioning analysis (RPA) class, and interval from tumor diagnosis to irradiation. Subgroup analyses were performed for RPA class I and II patients.

Results

1-year-OS was 53% after SRS and 56% after WBRT + SRS (p = 0.24). 1-year-IC rates were 51% and 66% (p = 0.015), respectively. 1-year-LC rates were 66% and 87% (p = 0.003), respectively. On multivariate analyses, OS was associated with age (p = 0.004), ECOG-PS (p = 0.005), extracerebral metastases (p < 0.001), RPA class (p < 0.001), and interval from tumor diagnosis to irradiation (p < 0.001). IC was associated with interval from tumor diagnosis to irradiation (p = 0.004) and almost with treatment (p = 0.09), and LC with treatment (p = 0.026) and almost with interval (p = 0.08). The results of the subgroup analyses were similar to those of the entire cohort. The increase in IC was stronger in RPA class I patients.

Conclusion

WBRT + SRS resulted in better IC and LC but not better OS than SRS alone. Because also IC and LC are important end-points, additional WBRT appears justified in patients with one to three brain metastases, in particular in RPA class I patients.

Zusammenfassung

Hintergrund

Die bestmögliche Behandlung von Patienten mit 1 bis 3 Hirnmetastasen ist unklar. Diese Studie vergleicht die Ergebnisse der alleinigen Radiochirurgie (SRS) mit den Ergebnissen nach Ganzhirnbestrahlung plus stereotaktischem Boost (WBRT + SRS).

Patienten und Methodik

Gesamtüberleben, intrazerebrale Kontrolle (IC) und lokale Kontrolle der behandelten Metastasen (LC) wurden retrospektiv bei 144 Patienten (93 SRS, 51 WBRT + SRS) ausgewertet (Tabelle 1). Acht weitere mögliche Prognosefaktoren wurden untersucht: Alter, Geschlecht, Allgemeinzustand, Primärtumor, Zahl der Hirnmetastasen, extrazerebrale Metastasierung, RPA-(Recursive-Partitioning-Analysis-)Klasse und Intervall von Erstdiagnose der Tumorerkrankung bis Strahlentherapie. Für die RPA-Klassen I und II wurden Subgruppenanalysen durchgeführt.

Ergebnisse

Das Gesamtüberleben nach 1 Jahr betrug 53% nach SRS und 56% nach WBRT + SRS (p = 0,24) (Abbildung 1, Tabelle 2). Die Raten für die 1-Jahres-IC waren 51% und 66% (p = 0,015), die Raten für die 1-Jahres-LC 66% und 87% (p = 0,003) (Abbildungen 1 und 2, Tabellen 3 und 4). In der Multivarianzanalyse war das Gesamtüberleben mit dem Alter (p = 0,004), dem Allgemeinzustand (p = 0,005), extrazerebraler Metastasierung (p < 0,001), RPA-Klasse (p < 0,001) und dem Intervall von Erstdiagnose bis Strahlentherapie (p < 0,001) assoziiert. Die IC war mit dem Intervall (p = 0,004) und annähernd mit dem Behandlungsregime (p = 0,09), die LC mit dem Behandlungsregime (p = 0,026) und annähernd mit dem Intervall assoziiert (p = 0,08). Die Ergebnisse der Subgruppenanalysen waren denen der Gesamtstudie vergleichbar, wobei die Verbesserung der IC in der RPA-Klasse I ausgeprägter war (Tabelle 5).

Schlussfolgerung

Die Kombination aus WBRT und SRS führte zu besserer IC und LC als die alleinige SRS, aber nicht zu besserem Gesamtüberleben. Da auch IC und LC wichtige Endpunkte sind, erscheint die zusätzliche WBRT bei Patienten mit 1 bis 3 Hirnmetastasen gerechtfertigt, insbesondere bei Patienten der RPA-Klasse I.

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Authors and Affiliations

  1. Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Luebeck, Germany

    Dirk Rades M.D., Jan-Dirk Kueter & Juergen Dunst

  2. Department of Radiation Oncology, University Medical Center, Hamburg, Germany

    Dirk Rades M.D. & Dagmar Hornung

  3. Department of Radiation Oncology, Dr. Bernard Verbeeten Institute, Tilburg, The Netherlands

    Theo Veninga & Patrick Hanssens

  4. Department of Radiation Oncology, Mayo Clinic Scottsdale, Arizona, USA

    Steven E. Schild

  5. Department of Radiation Oncology, University Hospital Schleswig-Holstein Campus Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany

    Dirk Rades M.D.

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  1. Dirk Rades M.D.
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  2. Jan-Dirk Kueter
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  3. Dagmar Hornung
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  7. Juergen Dunst
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Correspondence to Dirk Rades M.D..

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Rades, D., Kueter, JD., Hornung, D. et al. Comparison of stereotactic radiosurgery (SRS) alone and whole brain radiotherapy (WBRT) plus a stereotactic boost (WBRT + SRS) for one to three brain metastases. Strahlenther Onkol 184, 655–662 (2008). https://doi.org/10.1007/s00066-008-1946-8

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  • DOI: https://doi.org/10.1007/s00066-008-1946-8

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