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Stereotactic radiosurgery alone versus resection plus whole‐brain radiotherapy for 1 or 2 brain metastases in recursive partitioning analysis class 1 and 2 patients
Author(s) -
Rades Dirk,
Bohlen Guenther,
Pluemer Andre,
Veninga Theo,
Hanssens Patrick,
Dunst Juergen,
Schild Steven E.
Publication year - 2007
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.22729
Subject(s) - radiosurgery , recursive partitioning , medicine , radiation therapy , class (philosophy) , resection , brain metastasis , stereotactic radiotherapy , radiology , oncology , surgery , cancer , metastasis , artificial intelligence , computer science
BACKGROUND. The objective of this study was to compare stereotactic radiosurgery (SRS) alone with resection plus whole‐brain radiotherapy (WBRT) for the treatment of patients in recursive partitioning analysis (RPA) class 1 and 2 who had 1 or 2 brain metastases. METHODS. Two hundred six patients in RPA class 1 and 2 who had 1 or 2 brain metastases were analyzed retrospectively. Patients in Group A (n = 94) received from 18 grays (Gy) to 25 Gy SRS, and patients in Group B (n = 112) underwent resection of their metastases and received 10 × 3 Gy/20 × 2 Gy WBRT. Eight other potential prognostic factors were evaluated regarding overall survival (OS), brain control (BC), and local control (LC) of treated metastases: age, sex, performance status, tumor type, number of brain metastases, extracranial metastases, RPA class, and interval from tumor diagnosis to treatment of brain metastases. RESULTS. A comparison of the 2 treatment groups did not reveal significantly different OS ( P = .19), BC ( P = .52), or LC ( P = .25). In RPA subgroup analyses, outcome also did not differ significantly for either RPA class of patients ( P values from .21 to .83). On multivariate analysis, improved OS was associated with age ≤60 years (relative risk [RR], 1.75; P = .002), better performance status (RR, 1.67; P = .015), no extracranial metastases (RR, 2.84; P < .001), interval from tumor diagnosis to treatment >12 months (RR, 1.70; P = .003), and RPA class 1 (RR, 1.51; P = .016). Improved BC was associated with a single metastasis (RR, 1.54; P = .034) and an interval from tumor diagnosis to treatment >12 months (RR, 1.58; P = .019), and improved LC was associated with an interval from tumor diagnosis to treatment >12 months (RR, 1.59; P = .047). CONCLUSIONS. SRS alone appeared to be as effective as resection plus WBRT in the treatment of 1 or 2 brain metastases for patients in RPA class 1 and 2. Patient outcomes were associated with age, Karnofsky performance status, number of brain metastases, extracranial metastases, RPA class, and interval from tumor diagnosis to treatment. Cancer 2007. © 2007 American Cancer Society.