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- Title
Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial.
- Authors
Aoyama H; Shirato H; Tago M; Nakagawa K; Toyoda T; Hatano K; Kenjyo M; Oya N; Hirota S; Shioura H; Kunieda E; Inomata T; Hayakawa K; Katoh N; Kobashi G; Aoyama, Hidefumi; Shirato, Hiroki; Tago, Masao; Nakagawa, Keiichi; Toyoda, Tatsuya
- Abstract
<bold>Context: </bold>In patients with brain metastases, it is unclear whether adding up-front whole-brain radiation therapy (WBRT) to stereotactic radiosurgery (SRS) has beneficial effects on mortality or neurologic function compared with SRS alone.<bold>Objective: </bold>To determine if WBRT combined with SRS results in improvements in survival, brain tumor control, functional preservation rate, and frequency of neurologic death.<bold>Design, Setting, and Patients: </bold>Randomized controlled trial of 132 patients with 1 to 4 brain metastases, each less than 3 cm in diameter, enrolled at 11 hospitals in Japan between October 1999 and December 2003.<bold>Interventions: </bold>Patients were randomly assigned to receive WBRT plus SRS (65 patients) or SRS alone (67 patients).<bold>Main Outcome Measures: </bold>The primary end point was overall survival; secondary end points were brain tumor recurrence, salvage brain treatment, functional preservation, toxic effects of radiation, and cause of death.<bold>Results: </bold>The median survival time and the 1-year actuarial survival rate were 7.5 months and 38.5% (95% confidence interval, 26.7%-50.3%) in the WBRT + SRS group and 8.0 months and 28.4% (95% confidence interval, 17.6%-39.2%) for SRS alone (P = .42). The 12-month brain tumor recurrence rate was 46.8% in the WBRT + SRS group and 76.4% for SRS alone group (P<.001). Salvage brain treatment was less frequently required in the WBRT + SRS group (n = 10) than with SRS alone (n = 29) (P<.001). Death was attributed to neurologic causes in 22.8% of patients in the WBRT + SRS group and in 19.3% of those treated with SRS alone (P = .64). There were no significant differences in systemic and neurologic functional preservation and toxic effects of radiation.<bold>Conclusions: </bold>Compared with SRS alone, the use of WBRT plus SRS did not improve survival for patients with 1 to 4 brain metastases, but intracranial relapse occurred considerably more frequently in those who did not receive WBRT. Consequently, salvage treatment is frequently required when up-front WBRT is not used.<bold>Trial Registration: </bold>umin.ac.jp/ctr Identifier: C000000412.
- Publication
JAMA: Journal of the American Medical Association, 2006, Vol 295, Issue 21, p2483
- ISSN
0098-7484
- Publication type
journal article
- DOI
10.1001/jama.295.21.2483