Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial.
BACKGROUND
For the treatment of a single metastasis to the brain, surgical resection combined with postoperative radiotherapy is more effective than treatment with radiotherapy alone. However, the efficacy of postoperative radiotherapy after complete surgical resection has not been established.


OBJECTIVE
To determine if postoperative radiotherapy resulted in improved neurologic control of disease and increased survival.


METHODS
Multicenter, randomized, parallel group trial.


METHODS
University-affiliated cancer treatment facilities.


METHODS
Ninety-five patients who had single metastases to the brain that were treated with complete surgical resections (as verified by postoperative magnetic resonance imaging) between September 1989 and November 1997 were entered into the study.


METHODS
Patients were randomly assigned to treatment with postoperative whole-brain radiotherapy (radiotherapy group, 49 patients) or no further treatment (observation group, 46 patients) for the brain metastasis, with median follow-up of 48 weeks and 43 weeks, respectively.


METHODS
The primary end point was recurrence of tumor in the brain; secondary end points were length of survival, cause of death, and preservation of ability to function independently.


RESULTS
Recurrence of tumor anywhere in the brain was less frequent in the radiotherapy group than in the observation group (9 [18%] of 49 vs 32 [70%] of 46; P<.001). Postoperative radiotherapy prevented brain recurrence at the site of the original metastasis (5 [10%] of 49 vs 21 [46%] of 46; P<.001) and at other sites in the brain (7 [14%] of 49 vs 17 [37%] of 46; P<.01). Patients in the radiotherapy group were less likely to die of neurologic causes than patients in the observation group (6 [14%] of 43 who died vs 17 [44%] of 39; P=.003). There was no significant difference between the 2 groups in overall length of survival or the length of time that patients remained functionally independent.


CONCLUSIONS
Patients with cancer and single metastases to the brain who receive treatment with surgical resection and postoperative radiotherapy have fewer recurrences of cancer in the brain and are less likely to die of neurologic causes than similar patients treated with surgical resection alone.
Patchell
R A
RA
Department of Neurosurgery, University of Kentucky Medical Center, Lexington 40536-0084, USA. RPatchell@aol.com
Tibbs
P A
PA
Regine
W F
WF
Dempsey
R J
RJ
Mohiuddin
M
M
Kryscio
R J
RJ
Markesbery
W R
WR
Foon
K A
KA
Young
B
B
D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000556:secondary* / Q000601:surgery; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009483:Neuropsychological Tests; D018714:Radiotherapy, Adjuvant; D016019:Survival Analysis