A multi-institutional review of radiosurgery alone vs. radiosurgery with whole brain radiotherapy as the initial management of brain metastases

Sneed, Penny K; Suh, John H; Goetsch, Steven J; Sanghavi, Seema N; Chappell, Richard; Buatti, John M; Regine, William F; Weltman, Eduardo; King, Vernon J; Breneman, John C; Sperduto, Paul W; Mehta, Minesh P

Next »International Journal of Radiation Oncology * Biology * Physics
Volume 53, Issue 3 , Pages 519-526, 1 July 2002

A multi-institutional review of radiosurgery alone vs. radiosurgery with whole brain radiotherapy as the initial management of brain metastases

Penny K Sneed, M.D.
- Reprint requests to: Penny K. Sneed, M.D., Dept. of Radiation Oncology, Room L-08 (Box 0226), University of California, 505 Parnassus Avenue, San Francisco, CA 94143-0226 USA. Tel: (415) 353-8900; Fax: (415) 353-8679
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
John H Suh, M.D.
- Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH, USA
Steven J Goetsch, Ph.D.
- San Diego Gamma Knife Center, San Diego, CA, USA
Seema N Sanghavi, M.D.
- Department of Human Oncology, University of Wisconsin, Madison, WI, USA
Richard Chappell, Ph.D.
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, USA
John M Buatti, M.D.
- Department of Radiation Oncology, University of Iowa, Iowa City, IA, USA
William F Regine, M.D.
- Department of Radiation Medicine, University of Kentucky, Lexington, KY, USA
Eduardo Weltman, M.D.
- Department of Radiation Oncology, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
Vernon J King, M.D.
- Department of Radiation Oncology, Albany Medical Center, Albany, NY, USA
John C Breneman, M.D.
- Department of Radiology, University of Cincinnati, Cincinnati, OH, USA
Paul W Sperduto, M.D.
- Department of Radiation Oncology, Methodist Hospital Cancer Center, Minneapolis, MN, USA
Minesh P Mehta, M.D.
- Department of Human Oncology, University of Wisconsin, Madison, WI, USA

Received 5 March 2001; accepted 11 February 2002.

Abstract

: Data collected from 10 institutions were reviewed to compare survival probabilities of patients with newly diagnosed brain metastases managed initially with radiosurgery (RS) alone vs. RS + whole brain radiotherapy (WBRT).

: A database was created from raw data submitted from 10 institutions on patients treated with RS for brain metastases. The major exclusion criteria were resection of a brain metastasis and interval from the end of WBRT until RS >1 month (to try to ensure that the up-front intent was to combine RS + WBRT and that RS was not given for recurrent brain metastases). Survival was estimated using the Kaplan-Meier method from the date of first treatment for brain metastases until death or last follow-up. Survival times were compared for patients managed initially with RS alone vs. RS + WBRT using the Cox proportional hazards model to adjust for known prognostic factors or Radiation Therapy Oncology Group recursive partitioning analysis (RPA) class.

: Out of 983 patients, 31 were excluded because treatment began after 6/1/98; 159 were excluded because brain metastases were resected; 179 were excluded because there was an interval >1 month from WBRT until RS; and 45 were excluded for other reasons. Of the 569 evaluable patients, 268 had RS alone initially (24% of whom ultimately had salvage WBRT), and 301 had RS + up-front WBRT. The median survival times for patients treated with RS alone initially vs. RS + WBRT were 14.0 vs. 15.2 months for RPA Class 1 patients, 8.2 vs. 7.0 months for Class 2, and 5.3 vs. 5.5 months for Class 3, respectively. With adjustment by RPA class, there was no survival difference comparing RS alone initially to RS + up-front WBRT (p = 0.33, hazard ratio = 1.09).