title: Radiosurgery for patients with brain metastases: a multi-institutional analysis, stratified by the RTOG recursive partitioning analysis method.
abstract: OBJECTIVE
  To estimate the potential improvement in survival for patients with brain metastases, stratified by the Radiation Therapy Oncology Group (RTOG) recursive partitioning analysis (RPA) class and treated with radiosurgery (RS) plus whole brain radiotherapy (WBRT).
  
  
  METHODS
  An analysis of the RS databases of 10 institutions identified patients with brain metastates treated with RS and WBRT. Patients were stratified into 1 of 3 RPA classes. Survival was evaluated using Kaplan-Meier estimates and proportional hazard regression analysis. A comparison of survival by class was carried out with the RTOG results in similar patients receiving WBRT alone.
  
  
  RESULTS
  Five hundred two patients were eligible (261 men and 241 women, median age 59 years, range 26-83). The overall median survival was 10.7 months. A higher Karnofsky performance status (p = 0.0001), a controlled primary (median survival = 11.6 vs. 8.8 months, p = 0.0023), absence of extracranial metastases (median survival 13.4 vs. 9.1 months, p = 0.0001), and lower RPA class (median survival 16.1 months for class I vs. 10.3 months for class II vs. 8.7 months for class III, p = 0.000007) predicted for improved survival. Gender, age, primary site, radiosurgery technique, and institution were not prognostic. The addition of RS boosted results in median survival (16.1, 10.3, and 8.7 months for classes I, II, and III, respectively) compared with the median survival (7.1, 4.2, and 2.3 months, p <0.05) observed in the RTOG RPA analysis for patients treated with WBRT alone.
  
  
  CONCLUSIONS
  In the absence of randomized data, these results suggest that RS may improve survival in patients with BM. The improvement in survival does not appear to be restricted by class for well-selected patients.
authors.affiliation: University of Wisconsin, Madison, WI 53792, USA.
authors.forename: S N
authors.initials: SN
authors.lastname: Sanghavi
authors.forename: S S
authors.initials: SS
authors.lastname: Miranpuri
authors.forename: R
authors.initials: R
authors.lastname: Chappell
authors.forename: J M
authors.initials: JM
authors.lastname: Buatti
authors.forename: P K
authors.initials: PK
authors.lastname: Sneed
authors.forename: J H
authors.initials: JH
authors.lastname: Suh
authors.forename: W F
authors.initials: WF
authors.lastname: Regine
authors.forename: E
authors.initials: E
authors.lastname: Weltman
authors.forename: V J
authors.initials: VJ
authors.lastname: King
authors.forename: S J
authors.initials: SJ
authors.lastname: Goetsch
authors.forename: J C
authors.initials: JC
authors.lastname: Breneman
authors.forename: P W
authors.initials: PW
authors.lastname: Sperduto
authors.forename: C
authors.initials: C
authors.lastname: Scott
authors.forename: S
authors.initials: S
authors.lastname: Mabanta
authors.forename: M P
authors.initials: MP
authors.lastname: Mehta
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001932:Brain Neoplasms / Q000401:mortality* / Q000532:radiotherapy / Q000556:secondary / Q000601:surgery*; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery; D012189:Retrospective Studies; D016019:Survival Analysis