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Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial.

Publication ,  Journal Article
Andrews, DW; Scott, CB; Sperduto, PW; Flanders, AE; Gaspar, LE; Schell, MC; Werner-Wasik, M; Demas, W; Ryu, J; Bahary, J-P; Souhami, L ...
Published in: Lancet
May 22, 2004

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.

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Published In

Lancet

DOI

EISSN

1474-547X

Publication Date

May 22, 2004

Volume

363

Issue

9422

Start / End Page

1665 / 1672

Location

England

Related Subject Headings

  • Survival Rate
  • Radiotherapy Dosage
  • Radiosurgery
  • Radiation Injuries
  • Prognosis
  • Multivariate Analysis
  • Middle Aged
  • Male
  • Humans
  • General & Internal Medicine
 

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Andrews, D. W., Scott, C. B., Sperduto, P. W., Flanders, A. E., Gaspar, L. E., Schell, M. C., … Curran, W. J. (2004). Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet, 363(9422), 1665–1672. https://doi.org/10.1016/S0140-6736(04)16250-8
Andrews, David W., Charles B. Scott, Paul W. Sperduto, Adam E. Flanders, Laurie E. Gaspar, Michael C. Schell, Maria Werner-Wasik, et al. “Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial.Lancet 363, no. 9422 (May 22, 2004): 1665–72. https://doi.org/10.1016/S0140-6736(04)16250-8.
Andrews, David W., et al. “Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial.Lancet, vol. 363, no. 9422, May 2004, pp. 1665–72. Pubmed, doi:10.1016/S0140-6736(04)16250-8.
Andrews DW, Scott CB, Sperduto PW, Flanders AE, Gaspar LE, Schell MC, Werner-Wasik M, Demas W, Ryu J, Bahary J-P, Souhami L, Rotman M, Mehta MP, Curran WJ. Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet. 2004 May 22;363(9422):1665–1672.
Journal cover image

Published In

Lancet

DOI

EISSN

1474-547X

Publication Date

May 22, 2004

Volume

363

Issue

9422

Start / End Page

1665 / 1672

Location

England

Related Subject Headings

  • Survival Rate
  • Radiotherapy Dosage
  • Radiosurgery
  • Radiation Injuries
  • Prognosis
  • Multivariate Analysis
  • Middle Aged
  • Male
  • Humans
  • General & Internal Medicine