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

University of Rochester, Rochester, New York, United States
The Lancet (Impact Factor: 45.22). 06/2004; 363(9422):1665-72. DOI: 10.1016/S0140-6736(04)16250-8
Source: PubMed


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).
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.
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).
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.

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Available from: Minesh P Mehta, Mar 02, 2015
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    • "Une décennie plus tard, l'impact de la radiochirurgie (radiothérapie stéréotaxique focalisée délivrée en une seule séance) a été évaluée dans la prise en charge des métastases cérébrales (une à trois) avec des résultats également satisfaisants en termes de survie et de contrôle local par comparaison à ceux de l'irradiation pancérébrale seule [14] "
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    • "During the past few decades stereotactic radiosurgery (SRS) has become more common, either as a boost in combination with whole brain radiation, or used alone. The randomized RTOG-9508 study found that adding SRS to whole brain irradiation improved local control rates [2]. SRS uses very intense treatments such as 15–24 Gy in a single fraction [3] [4], which results in ablation of tissue inside the target zone and excellent tumor control. "
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    • "Stereotactic radiosurgery (SRS) delivers a single high dose of irradiation to the target volume while avoiding the surrounding normal tissues. A randomized trial conducted by the RTOG (22) showed that the addition of SRS to WBRT was superior to WBRT alone in patients with a newly diagnosed single brain lesion. A survival benefit was not seen for patients with two or three metastatic lesions, although local brain control was significantly improved with the addition of SRS. "
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