A Matched-Pair Analysis Comparing Whole-Brain Radiotherapy Plus Stereotactic Radiosurgery Versus Surgery Plus Whole-Brain Radiotherapy and a Boost to the Metastatic Site for One or Two Brain Metastases

Rades, Dirk; Kueter, Jan-Dirk; Pluemer, Andre; Veninga, Theo; Schild, Steven E.

doi:10.1016/j.ijrobp.2008.05.035

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Volume 73, Issue 4 , Pages 1077-1081, 15 March 2009

A Matched-Pair Analysis Comparing Whole-Brain Radiotherapy Plus Stereotactic Radiosurgery Versus Surgery Plus Whole-Brain Radiotherapy and a Boost to the Metastatic Site for One or Two Brain Metastases

Dirk Rades, M.D.
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
- Department of Radiation Oncology, University Medical Center, Hamburg, Germany
- Reprint requests to: Dirk Rades, M.D., Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, D-23538 Luebeck, Germany. Tel: (+49) 451-500-6661; Fax: (+49) 451-500-3324
Jan-Dirk Kueter, M.D.
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
Andre Pluemer, M.D.
- Department of Radiation Oncology, University Medical Center, Hamburg, Germany
Theo Veninga, M.D.
- Department of Radiation Oncology, Dr. Bernard Verbeeten Institute, Tilburg, The Netherlands
Steven E. Schild, M.D.
- Department of Radiation Oncology, Mayo Clinic Scottsdale, Scottsdale, AZ

Received 23 March 2008; received in revised form 6 May 2008; accepted 8 May 2008. published online 15 August 2008.

Purpose

To compare the results of whole-brain radiotherapy plus stereotactic radiosurgery (WBRT+SRS) with those of surgery plus whole-brain radiotherapy and a boost to the metastatic site (OP+WBRT+boost) for patients with one or two brain metastases.

Methods and Materials

Survival, intracerebral control, and local control of the treated metastases were retrospectively evaluated. To reduce the risk of selection bias, a matched-pair analysis was performed. The outcomes of 47 patients who received WBRT+SRS were compared with those of a second cohort of 47 patients who recieved OP+WBRT+boost. The two treatment groups were matched for the following potential prognostic factors: WBRT schedule, age, gender, performance status, tumor type, number of brain metastases, extracerebral metastases, recursive partitioning analysis class, and interval from tumor diagnosis to WBRT.

Results

The 1-year survival rates were 65% after WBRT+SRS and 63% after OP+WBRT+boost (p = 0.19). The 1-year intracerebral control rates were 70% and 78% (p = 0.39), respectively. The 1-year local control rates were 84% and 83% (p = 0.87), respectively. On multivariate analyses, improved survival was significantly associated with better performance status (p = 0.009), no extracerebral metastases (p = 0.004), recursive partitioning analysis Class 1 (p = 0.004), and interval from tumor diagnosis to WBRT (p = 0.001). Intracerebral control was not significantly associated with any of the potential prognostic factors. Improved local control was significantly associated with no extracerebral metastases (p = 0.037).

Conclusions

Treatment outcomes were not significantly different after WBRT+SRS compared with OP+WBRT+boost. However, WBRT+SRS is less invasive than OP+WBRT+boost and may be preferable for patients with one or two brain metastases. The results should be confirmed by randomized trials.

Brain metastases, Stereotactic radiosurgery, Brain surgery, Radiation boost, Treatment outcome