Surgical Resection Followed by Whole Brain Radiotherapy Versus Whole Brain Radiotherapy Alone for Single Brain Metastasis

Rades, Dirk; Kieckebusch, Susanne; Haatanen, Tiina; Lohynska, Radka; Dunst, Juergen; Schild, Steven E.

doi:10.1016/j.ijrobp.2007.08.009

« Previous Next »International Journal of Radiation Oncology * Biology * Physics
Volume 70, Issue 5 , Pages 1319-1324, 1 April 2008

Surgical Resection Followed by Whole Brain Radiotherapy Versus Whole Brain Radiotherapy Alone for Single Brain Metastasis

Dirk Rades, M.D.
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Luebeck, Germany
- Department of Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Reprint requests to: Dirk Rades, M.D., Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, Luebeck D-23538 Germany. Tel: (+49) 451-500-6661; Fax: (+49) 451-500-3324
Susanne Kieckebusch, M.D.
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Luebeck, Germany
Tiina Haatanen, M.D.
- Department of Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
Radka Lohynska, M.D.
- Department of Radiation Oncology, University Hospital, Prague, Czech Republic
Juergen Dunst, M.D.
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Luebeck, Germany
Steven E. Schild, M.D.
- Department of Radiation Oncology, Mayo Clinic Scottsdale, Scottsdale, AZ

Received 19 June 2007; received in revised form 10 August 2007; accepted 10 August 2007.

Purpose

To compare the outcome of surgical resection followed by whole brain radiotherapy (WBRT) with WBRT alone in patients treated for single brain metastasis.

Methods and Materials

The data from 195 patients with single brain metastases were retrospectively evaluated. Of the 195 patients, 99 underwent resection of the metastasis followed by WBRT and 96 underwent WBRT alone. Seven additional potential prognostic factors were investigated: age, gender, Eastern Cooperative Oncology Group performance score, tumor type, interval between initial tumor diagnosis and WBRT, extracranial metastases, and recursive partitioning analysis class. Both treatment groups were well balanced for these factors.

Results

On multivariate analysis, improved survival was associated with resection (relative risk [RR], 1.20; 95% confidence interval [CI], 1.11–1.31; p < 0.001), lower recursive partitioning analysis class (RR, 1.58; 95% CI, 1.22–2.06; p < 0.001), age ≤61 years (RR, 1.79; 95% CI, 1.23–2.61; p = 0.002), Eastern Cooperative Oncology Group performance score of 0–1 (RR, 2.47; 95% CI, 1.70–3.59; p < 0.001), and the absence of extracranial metastases (RR, 1.99; 95% CI, 1.41–2.79; p < 0.001). Improved local control was associated with resection (RR, 1.25; 95% CI, 1.11–1.41; p < 0.001) and age ≤61 years (RR, 1.77; 95% CI, 1.09–2.88; p = 0.020). Improved brain control distant from the original site was associated with lower recursive partitioning analysis class (RR, 1.65; 95% CI, 1.03–2.69; p < 0.035), age ≤61 years (RR, 1.81; 95% CI, 1.12–2.96; p = 0.016), and the absence of extracranial metastases (RR, 2.42; 95% CI, 1.52–3.88; p < 0.001). Improved control within the entire brain was associated with surgery (RR, 1.24; 95% CI, 1.12–1.38; p < 0.001) and age ≤61 years (RR, 1.83; 95% CI, 1.21–2.77; p = 0.004).

Conclusion

In patients with a single brain metastasis, the addition of resection to WBRT improved survival, local control at the original metastatic site, and control within the entire brain, but did not prevent the development of new brain metastases distant to the original site.

Single brain metastases, Whole-brain radiotherapy, Surgery, Prognostic factors, Treatment outcome