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Subject: 1 selected item: 15158627 - PubMed
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Affiliation
1 Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. david.andrews@jefferson.edu
David W Andrews et al. Lancet. 2004.
Affiliation
1 Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107, USA. david.andrews@jefferson.edu
Background: 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).
Methods: 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.
Findings: 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).
Interpretation: 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.
Schüttrumpf LH, Niyazi M, Nachbichler SB, Manapov F, Jansen N, Siefert A, Belka C. Schüttrumpf LH, et al. Radiat Oncol. 2014 May 2;9:105. doi: 10.1186/1748-717X-9-105. Radiat Oncol. 2014. PMID: 24885624 Free PMC article.
Hall MD, McGee JL, McGee MC, Hall KA, Neils DM, Klopfenstein JD, Elwood PW. Hall MD, et al. J Neurosurg. 2014 Dec;121 Suppl:84-90. doi: 10.3171/2014.7.GKS14972. J Neurosurg. 2014. PMID: 25434941
Buchsbaum JC, Suh JH, Lee SY, Chidel MA, Greskovich JF, Barnett GH. Buchsbaum JC, et al. Cancer. 2002 Apr 15;94(8):2265-72. doi: 10.1002/cncr.10426. Cancer. 2002. PMID: 12001126
Mehta MP, Tsao MN, Whelan TJ, Morris DE, Hayman JA, Flickinger JC, Mills M, Rogers CL, Souhami L. Mehta MP, et al. Int J Radiat Oncol Biol Phys. 2005 Sep 1;63(1):37-46. doi: 10.1016/j.ijrobp.2005.05.023. Int J Radiat Oncol Biol Phys. 2005. PMID: 16111570 Review.
Tsao MN, Lloyd N, Wong RK, Chow E, Rakovitch E, Laperriere N, Xu W, Sahgal A. Tsao MN, et al. Cochrane Database Syst Rev. 2012 Apr 18;2012(4):CD003869. doi: 10.1002/14651858.CD003869.pub3. Cochrane Database Syst Rev. 2012. PMID: 22513917 Free PMC article. Updated. Review.
Pan M. Pan M. Adv Radiat Oncol. 2021 Jun 2;6(5):100733. doi: 10.1016/j.adro.2021.100733. eCollection 2021 Sep-Oct. Adv Radiat Oncol. 2021. PMID: 34286165 Free PMC article. No abstract available.
Boström JP, Jetschke K, Schmieder K, Adamietz IUA. Boström JP, et al. Radiologe. 2021 Jul 16. doi: 10.1007/s00117-021-00894-4. Online ahead of print. Radiologe. 2021. PMID: 34272570 German.
Sun MS, Liu YH, Ye JM, Liu Q, Cheng YJ, Xin L, Xu L. Sun MS, et al. Ann Transl Med. 2021 May;9(10):853. doi: 10.21037/atm-21-1808. Ann Transl Med. 2021. PMID: 34164487 Free PMC article.
Suwinski R. Suwinski R. J Thorac Dis. 2021 May;13(5):3315-3322. doi: 10.21037/jtd-2019-rbmlc-08. J Thorac Dis. 2021. PMID: 34164224 Free PMC article. Review.
Socha J, Rychter A, Kepka L. Socha J, et al. J Thorac Dis. 2021 May;13(5):3295-3307. doi: 10.21037/jtd-2019-rbmlc-05. J Thorac Dis. 2021. PMID: 34164222 Free PMC article. Review.

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