35. RTOG 9508: A prospective randomized trial of stereotactic radiosurgery and whole brain radiation therapy versus whole brain radiation therapy alone in patients with 1-3 brain métastases patients; results and salvage therapy analyses

Purpose/Objective: To determine if Stereotactic radiosurgery (SRS) after conventional whole brain radiation therapy (WERT) improves overall survival when compared to WERT alone in patients with 1-3 brain métastases. Materials / Methods: Between 1/96 and 6/01, 333 patients from 34 institutions were randomized to receive WERT + SRS or WERT alone. Eligibility required histologie confirmation of malignancy, enhanced brain MR1 showing 1-3 brain métastases, maximum tumor diameter less than 4.0cm. Results: There was a statistically significant survival advantage with WERT + SRS for the following patients: solitary brain métastases (MST 6.5 vs 4.9 months, P = 0.04), RPA class 1 (MST 11.6 vs 9.6 months, P = 0.05), age less than 50 (9.9 vs 8.3 months, P = 0.04) and patients with non-small cell lung cancer or any squamous cell carcinoma (5.9 vs 3.9 months, P = 0.05). Furthermore, all patients in the WERT + SRS group were more likely to have a stable or improved performance status (KPS) at 3 months (50% vs 33%, P = 0.02) and at 6 months (43% vs 27%, P = 0.03). There was no significant difference in cause of death but there was a significant difference in local control as reported by the treating institution (82%vs71%atoneyearforWBRT + SRS vs WERT alone, respectively (P = 0.01). Conclusions: WBRT + SRS provided a survival advantage compared to WERT alone in each of the following patient categories: 1) solitary brain metastasis; 2) RPA class 1 ; 3) age less than 50; 4) non-small cell lung cancer or any squamous cell carcinoma. Furthermore, all subsets of patients in the WBRT + SRS group were more likely to have a stable or improved performance status than those in the WERT alone group. Cause of death and salvage analyses will be presented.

Duke Scholars

Author Paul Wayne Sperduto Radiation Oncology