Radiosurgery alone versus radiosurgery plus whole-brain irradiation for very few cerebral metastases from lung cancer

BMC Cancer

Steven E Schild³  Oliver Blanck²  Dagmar Hornung¹  Stefan Huttenlocher⁴  Dirk Rades⁴ 

[1]Department of Radiation Oncology, University Medical Center Eppendorf, Hamburg, Germany

[2]CyberKnife Centre Northern Germany, Güstrow, Germany

[3]Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA

[4]Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538 Lübeck, Germany

关键词: Outcomes;    Whole-brain irradiation;    Radiosurgery alone;    Cerebral metastasis;    Lung cancer;   

Others  :  1117916
DOI  :  10.1186/1471-2407-14-931

 received in 2014-10-06, accepted in 2014-11-25,  发布年份 2014

【 摘 要 】

Background

It is unclear whether patients with few cerebral metastases benefit from whole-brain irradiation added to radiosurgery. Since primary tumors disseminating to the brain show different behavior, this question should be answered separately for each tumor type. This study compared both treatments in patients with 1-3 cerebral metastases from lung cancer.

Methods

Ninety-eight patients receiving radiosurgery alone were retrospectively compared to 50 patients receiving radiosurgery plus whole-brain irradiation for local control, distant cerebral control and overall survival. Ten other characteristics were additionally considered including radiosurgery dose, age, gender, Eastern Cooperative Oncology Group (ECOG) performance score, histology, number of cerebral metastases, maximum diameter of all cerebral metastases, site of cerebral metastases, extra-cerebral metastases, and interval from lung cancer diagnosis to irradiation.

Results

The treatment approach had no significant impact on local control (p = 0.61). On multivariate analysis of local control, ECOG performance score was significant (risk ratio [RR]: 2.10; p < 0.001). The multivariate analysis of distant brain control revealed significant positive associations with radiosurgery plus whole-brain irradiation (RR: 4.67; p < 0.001) and one cerebral metastasis (RR: 2.62; p < 0.001). Treatment approach was not significantly associated with overall survival (p = 0.32). On multivariate analysis, significant associations with overall survival were found for maximum diameter of all cerebral metastases (RR: 1.81; p = 0.008), extra-cerebral metastases (RR: 2.98; p < 0.001), and interval from lung cancer diagnosis to irradiation (RR: 1.19; p < 0.001).

Conclusion

Addition of whole-brain irradiation to radiosurgery significantly improved distant brain control in patients with few cerebral metastases from lung cancer. This improvement did not translate into better overall survival.

【 授权许可】

   
2014 Rades et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Khuntia D, Brown P, Li J, Mehta MP: Whole-brain radiotherapy in the management of brain metastases. J Clin Oncol 2006, 24:1295-1304.
• [2]Dziggel L, Segedin B, Podvrsnik NH, Oblak I, Schild SE, Rades D: Validation of a survival score for patients treated with whole-brain radiotherapy for brain metastases. Strahlenther Onkol 2013, 189:364-366.
• [3]Chang EL, Wefel JS, Hess KR, Allen PK, Lang FF, Kornguth DG, Arbuckle RB, Swint JM, Shiu AS, Maor MH, Meyers CA: Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol 2009, 10:1037-1044.
• [4]Chiou SM: Survival of brain metastatic patients treated with Gamma Knife radiosurgery alone. Clin Neurol Neurosurg 2013, 115:276-284.
• [5]Mut M: Surgical treatment of brain metastasis: a review. Clin Neurol Neurosurg 2012, 114:1-8.
• [6]Kocher M, Soffietti R, Abacioglu U, Villà S, Fauchon F, Baumert BG, Fariselli L, Tzuk-Shina T, Kortmann RD, Carrie C, Ben Hassel M, Kouri M, Valeinis E, van den Berge D, Collette S, Collette L, Mueller RP: Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. J Clin Oncol 2011, 29:134-141.
• [7]Aoyama H, Shirato H, Tago M, Nakadawa K, Toyoda T, Hatano K, Kenjyo M, Oya N, Horota S, Snioura H, Kunieda E, Inomata T, Hayakawa K, Katoh N, Kobashi G: Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases. A randomized controlled trial. JAMA 2006, 295:2483-2491.
• [8]Aoyama H, Tago M, Kato N, Toyoda T, Kenjyo M, Hirota S, Shioura H, Inomata T, Kunieda E, Hayakawa K, Nakagawa K, Kobashi G, Shirato H: Neurocognitive function of patients with brain metastasis who received either whole brain radiotherapy plus stereotactic radiosurgery or radiosurgery alone. Int J Radiat Oncol Biol Phys 2007, 68:1388-1395.
• [9]Meyers CA, Smith JA, Bezjak A, Mehta MP, Liebmann J, Illidge T, Kunkler I, Caudrelier JM, Eisenberg PD, Meerwaldt J, Siemers R, Carrie C, Gaspar LE, Curran W, Phan SC, Miller RA, Renschler MF: Neurocognitive function and progression in patients with brain metastases treated with whole-brain radiation and motexafin gadolinium: results of a randomized phase III trial. J Clin Oncol 2004, 22:157-165.
• [10]Kress MA, Oermann E, Ewend MG, Hoffman RB, Chaudhry H, Collins B: Stereotactic radiosurgery for single brain metastases from non-small cell lung cancer: progression of extracranial disease correlates with distant intracranial failure. Radiat Oncol 2013, 8:64. BioMed Central Full Text
• [11]Ge XH, Lin Q, Ren XC, Liu YE, Chen XJ, Wang DY, Wang YQ, Cao B, Li ZG, Liu ML: Phase II clinical trial of whole-brain irradiation plus three-dimensional conformal boost with concurrent topotecan for brain metastases from lung cancer. Radiat Oncol 2013, 8:238. BioMed Central Full Text
• [12]Rades D, Dziggel L, Segedin B, Oblak I, Nagy V, Marita A, Schild SE, Trang NT, Khoa MT: A new survival score for patients with brain metastases from non-small cell lung cancer. Strahlenther Onkol 2013, 189:777-781.
• [13]Ozgen Z, Atasoy BM, Kefeli AU, Seker A, Dane F, Abacioglu U: The benefit of whole brain reirradiation in patients with multiple brain metastases. Radiat Oncol 2013, 8:186. BioMed Central Full Text
• [14]Huttenlocher S, Dziggel L, Hornung D, Blanck O, Schild SE, Rades D: A new prognostic instrument to predict the probability of developing new cerebral metastases after radiosurgery alone. Radiat Oncol 2014, 9:215. BioMed Central Full Text