Single brain metastasis

Whole-brain irradiation plus either radiosurgery or neurosurgical resection

Dirk Rades, Theo Veninga, Dagmar Hornung, Oliver Wittkugel, Steven E. Schild, Jan Gliemroth

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: The current study was conducted to compare neurosurgical resection (NR) followed by whole-brain irradiation (WBI) (NR + WBI) with WBI followed by radiosurgery (WBI + RS) in patients with a single brain metastasis. Methods: The outcome of 41 patients treated with WBI + RS was retrospectively compared with 111 patients who received NR;+ WBI with respect to local control of the treated metastasis and survival. Eleven additional potential prognostic factors were investigated, including WBI schedule, patient age, patient gender, Karnofsky performance score (KPS), primary tumor type, extracerebral metastases, recursive partitioning analysis (RPA) class, interval between the first diagnosis of cancer to the treatment of brain metastasis, metastatic site, maximum diameter of the metastasis, and graded prognostic assessment (GPA) score. Results: The 1-year local control rates were 87% after WBI + RS and 56% after NR + WBI (P =.001). Using the Cox proportional hazards model, the treatment regimen remained significant (risk ratio [RR], 2.46; 95% confidence interval [95% CI], 1.29-5.17 [P =.005]). On the multivariate analysis, local control was also found to be associated with the maximum diameter of the metastasis. The 1-year survival rates were 61% after WBI + RS and 53% after NR + WBI (P =.16). Acute and late toxicities were similar in both groups. On the multivariate analysis, KPS, extracerebral metastases, RPA class, and the GPA score were found to be independent predictors of survival. Conclusions: The use of WBI + RS resulted in significantly better local control of the treated metastasis than NR + WBI. Survival was not found to be significantly different in either group. Because WBI + RS is less invasive than NR + WBI, it appears to be preferable for many patients with a single brain metastasis. These results should be confirmed in a randomized trial.

Original languageEnglish (US)
Pages (from-to)1138-1144
Number of pages7
JournalCancer
Volume118
Issue number4
DOIs
StatePublished - Feb 15 2012

Fingerprint

Radiosurgery
Neoplasm Metastasis
Brain
Survival
Multivariate Analysis

Keywords

  • local control
  • neurosurgical resection
  • radiosurgery
  • single brain metastasis
  • survival

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Rades, D., Veninga, T., Hornung, D., Wittkugel, O., Schild, S. E., & Gliemroth, J. (2012). Single brain metastasis: Whole-brain irradiation plus either radiosurgery or neurosurgical resection. Cancer, 118(4), 1138-1144. https://doi.org/10.1002/cncr.26379

Single brain metastasis : Whole-brain irradiation plus either radiosurgery or neurosurgical resection. / Rades, Dirk; Veninga, Theo; Hornung, Dagmar; Wittkugel, Oliver; Schild, Steven E.; Gliemroth, Jan.

In: Cancer, Vol. 118, No. 4, 15.02.2012, p. 1138-1144.

Research output: Contribution to journalArticle

Rades, D, Veninga, T, Hornung, D, Wittkugel, O, Schild, SE & Gliemroth, J 2012, 'Single brain metastasis: Whole-brain irradiation plus either radiosurgery or neurosurgical resection', Cancer, vol. 118, no. 4, pp. 1138-1144. https://doi.org/10.1002/cncr.26379
Rades D, Veninga T, Hornung D, Wittkugel O, Schild SE, Gliemroth J. Single brain metastasis: Whole-brain irradiation plus either radiosurgery or neurosurgical resection. Cancer. 2012 Feb 15;118(4):1138-1144. https://doi.org/10.1002/cncr.26379
Rades, Dirk ; Veninga, Theo ; Hornung, Dagmar ; Wittkugel, Oliver ; Schild, Steven E. ; Gliemroth, Jan. / Single brain metastasis : Whole-brain irradiation plus either radiosurgery or neurosurgical resection. In: Cancer. 2012 ; Vol. 118, No. 4. pp. 1138-1144.
@article{0093a28e01e14338918cff3e0bc48006,
title = "Single brain metastasis: Whole-brain irradiation plus either radiosurgery or neurosurgical resection",
abstract = "Background: The current study was conducted to compare neurosurgical resection (NR) followed by whole-brain irradiation (WBI) (NR + WBI) with WBI followed by radiosurgery (WBI + RS) in patients with a single brain metastasis. Methods: The outcome of 41 patients treated with WBI + RS was retrospectively compared with 111 patients who received NR;+ WBI with respect to local control of the treated metastasis and survival. Eleven additional potential prognostic factors were investigated, including WBI schedule, patient age, patient gender, Karnofsky performance score (KPS), primary tumor type, extracerebral metastases, recursive partitioning analysis (RPA) class, interval between the first diagnosis of cancer to the treatment of brain metastasis, metastatic site, maximum diameter of the metastasis, and graded prognostic assessment (GPA) score. Results: The 1-year local control rates were 87{\%} after WBI + RS and 56{\%} after NR + WBI (P =.001). Using the Cox proportional hazards model, the treatment regimen remained significant (risk ratio [RR], 2.46; 95{\%} confidence interval [95{\%} CI], 1.29-5.17 [P =.005]). On the multivariate analysis, local control was also found to be associated with the maximum diameter of the metastasis. The 1-year survival rates were 61{\%} after WBI + RS and 53{\%} after NR + WBI (P =.16). Acute and late toxicities were similar in both groups. On the multivariate analysis, KPS, extracerebral metastases, RPA class, and the GPA score were found to be independent predictors of survival. Conclusions: The use of WBI + RS resulted in significantly better local control of the treated metastasis than NR + WBI. Survival was not found to be significantly different in either group. Because WBI + RS is less invasive than NR + WBI, it appears to be preferable for many patients with a single brain metastasis. These results should be confirmed in a randomized trial.",
keywords = "local control, neurosurgical resection, radiosurgery, single brain metastasis, survival",
author = "Dirk Rades and Theo Veninga and Dagmar Hornung and Oliver Wittkugel and Schild, {Steven E.} and Jan Gliemroth",
year = "2012",
month = "2",
day = "15",
doi = "10.1002/cncr.26379",
language = "English (US)",
volume = "118",
pages = "1138--1144",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "4",

}

TY - JOUR

T1 - Single brain metastasis

T2 - Whole-brain irradiation plus either radiosurgery or neurosurgical resection

AU - Rades, Dirk

AU - Veninga, Theo

AU - Hornung, Dagmar

AU - Wittkugel, Oliver

AU - Schild, Steven E.

AU - Gliemroth, Jan

PY - 2012/2/15

Y1 - 2012/2/15

N2 - Background: The current study was conducted to compare neurosurgical resection (NR) followed by whole-brain irradiation (WBI) (NR + WBI) with WBI followed by radiosurgery (WBI + RS) in patients with a single brain metastasis. Methods: The outcome of 41 patients treated with WBI + RS was retrospectively compared with 111 patients who received NR;+ WBI with respect to local control of the treated metastasis and survival. Eleven additional potential prognostic factors were investigated, including WBI schedule, patient age, patient gender, Karnofsky performance score (KPS), primary tumor type, extracerebral metastases, recursive partitioning analysis (RPA) class, interval between the first diagnosis of cancer to the treatment of brain metastasis, metastatic site, maximum diameter of the metastasis, and graded prognostic assessment (GPA) score. Results: The 1-year local control rates were 87% after WBI + RS and 56% after NR + WBI (P =.001). Using the Cox proportional hazards model, the treatment regimen remained significant (risk ratio [RR], 2.46; 95% confidence interval [95% CI], 1.29-5.17 [P =.005]). On the multivariate analysis, local control was also found to be associated with the maximum diameter of the metastasis. The 1-year survival rates were 61% after WBI + RS and 53% after NR + WBI (P =.16). Acute and late toxicities were similar in both groups. On the multivariate analysis, KPS, extracerebral metastases, RPA class, and the GPA score were found to be independent predictors of survival. Conclusions: The use of WBI + RS resulted in significantly better local control of the treated metastasis than NR + WBI. Survival was not found to be significantly different in either group. Because WBI + RS is less invasive than NR + WBI, it appears to be preferable for many patients with a single brain metastasis. These results should be confirmed in a randomized trial.

AB - Background: The current study was conducted to compare neurosurgical resection (NR) followed by whole-brain irradiation (WBI) (NR + WBI) with WBI followed by radiosurgery (WBI + RS) in patients with a single brain metastasis. Methods: The outcome of 41 patients treated with WBI + RS was retrospectively compared with 111 patients who received NR;+ WBI with respect to local control of the treated metastasis and survival. Eleven additional potential prognostic factors were investigated, including WBI schedule, patient age, patient gender, Karnofsky performance score (KPS), primary tumor type, extracerebral metastases, recursive partitioning analysis (RPA) class, interval between the first diagnosis of cancer to the treatment of brain metastasis, metastatic site, maximum diameter of the metastasis, and graded prognostic assessment (GPA) score. Results: The 1-year local control rates were 87% after WBI + RS and 56% after NR + WBI (P =.001). Using the Cox proportional hazards model, the treatment regimen remained significant (risk ratio [RR], 2.46; 95% confidence interval [95% CI], 1.29-5.17 [P =.005]). On the multivariate analysis, local control was also found to be associated with the maximum diameter of the metastasis. The 1-year survival rates were 61% after WBI + RS and 53% after NR + WBI (P =.16). Acute and late toxicities were similar in both groups. On the multivariate analysis, KPS, extracerebral metastases, RPA class, and the GPA score were found to be independent predictors of survival. Conclusions: The use of WBI + RS resulted in significantly better local control of the treated metastasis than NR + WBI. Survival was not found to be significantly different in either group. Because WBI + RS is less invasive than NR + WBI, it appears to be preferable for many patients with a single brain metastasis. These results should be confirmed in a randomized trial.

KW - local control

KW - neurosurgical resection

KW - radiosurgery

KW - single brain metastasis

KW - survival

UR - http://www.scopus.com/inward/record.url?scp=84856792912&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84856792912&partnerID=8YFLogxK

U2 - 10.1002/cncr.26379

DO - 10.1002/cncr.26379

M3 - Article

VL - 118

SP - 1138

EP - 1144

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 4

ER -