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

Dirk Rades, Jan Dirk Kueter, Dagmar Hornung, Theo Veninga, Patrick Hanssens, Steven E. Schild, Juergen Dunst

Research output: Contribution to journalArticle

43 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)655-662
Number of pages8
JournalStrahlentherapie und Onkologie
Volume184
Issue number12
DOIs
StatePublished - Dec 2008

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Radiosurgery
Radiotherapy
Neoplasm Metastasis
Brain
Neoplasms
Brain Neoplasms
Therapeutics
Multivariate Analysis
Survival

Keywords

  • Brain metastases
  • Stereotactic radiosurgery
  • Treatment outcome
  • Whole brain radiation therapy

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Oncology

Cite this

Comparison of stereotactic radiosurgery (SRS) alone and whole brain radiotherapy (WBRT) plus a stereotactic boost (WBRT + SRS) for one to three brain metastases. / Rades, Dirk; Kueter, Jan Dirk; Hornung, Dagmar; Veninga, Theo; Hanssens, Patrick; Schild, Steven E.; Dunst, Juergen.

In: Strahlentherapie und Onkologie, Vol. 184, No. 12, 12.2008, p. 655-662.

Research output: Contribution to journalArticle

Rades, Dirk ; Kueter, Jan Dirk ; Hornung, Dagmar ; Veninga, Theo ; Hanssens, Patrick ; Schild, Steven E. ; Dunst, Juergen. / Comparison of stereotactic radiosurgery (SRS) alone and whole brain radiotherapy (WBRT) plus a stereotactic boost (WBRT + SRS) for one to three brain metastases. In: Strahlentherapie und Onkologie. 2008 ; Vol. 184, No. 12. pp. 655-662.
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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.",
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T1 - Comparison of stereotactic radiosurgery (SRS) alone and whole brain radiotherapy (WBRT) plus a stereotactic boost (WBRT + SRS) for one to three brain metastases

AU - Rades, Dirk

AU - Kueter, Jan Dirk

AU - Hornung, Dagmar

AU - Veninga, Theo

AU - Hanssens, Patrick

AU - Schild, Steven E.

AU - Dunst, Juergen

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N2 - 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.

AB - 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.

KW - Brain metastases

KW - Stereotactic radiosurgery

KW - Treatment outcome

KW - Whole brain radiation therapy

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