title: Whole-brain radiotherapy combined with surgery or stereotactic radiotherapy in patients with brain oligometastases: long-term analysis.
abstract: OBJECTIVE
  To verify whether the treatment of brain oligometastases with whole-brain radiotherapy (WBRT) plus stereotactic radiotherapy (SRT) or surgical resection results in different outcomes.
  
  
  METHODS
  Files of patients affected by brain metastases submitted to surgical resection followed by WBRT (group A) or WBRT + SRT (group B) were retrospectively selected for this study. The two treatment groups were matched for the following potential prognostic factors: WBRT schedule, age, gender, performance status, tumor type, number of brain metastases, extra-cerebral metastases, and recursive partitioning analysis class (RPA). The outcomes of patients in both groups were evaluated in terms of toxicity, local control, and overall survival.
  
  
  RESULTS
  Total of 97 patients were selected (56 male; 42 female) who were respectively submitted to surgical resection followed by WBRT (group A, n = 50 patients) or WBRT + SRT (Group B, n = 47 patients). Median follow-up was 95 months (range, 8-171 months). The 1-year local control rates were 46.0% and 69.0% respectively. No significant difference in local tumor control was observed between group A and B (p = 0.10). Median overall survival was 15 and 19 months in group A and B, respectively. One-year survival was 56.0% and 62%, respectively. No difference was observed in the two groups (p = 0.40).
  
  
  CONCLUSIONS
  Surgery remains the main therapeutic approach in symptomatic patients; nevertheless, our data support the use of WBRT plus SRT in one or two brain metastases smaller than 3 cm.
authors.affiliation: Dept. of Radiation Oncology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Giuseppe Roberto
authors.initials: GR
authors.lastname: D'Agostino
authors.forename: Rosa
authors.initials: R
authors.lastname: Autorino
authors.forename: Angelo
authors.initials: A
authors.lastname: Pompucci
authors.forename: Maria Carmen
authors.initials: MC
authors.lastname: De Santis
authors.forename: Stefania
authors.initials: S
authors.lastname: Manfrida
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Lella
authors.forename: Giovanna
authors.initials: G
authors.lastname: Mantini
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Frascino
authors.forename: Silvia
authors.initials: S
authors.lastname: Chiesa
authors.forename: Alessio
authors.initials: A
authors.lastname: Albanese
authors.forename: Nicola
authors.initials: N
authors.lastname: Dinapoli
authors.forename: Luigi
authors.initials: L
authors.lastname: Azario
authors.forename: Alba
authors.initials: A
authors.lastname: Fiorentino
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Valentini
authors.forename: Carmelo
authors.initials: C
authors.lastname: Anile
authors.forename: Mario
authors.initials: M
authors.lastname: Balducci
mesh_terms: D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000556:secondary* / Q000601:surgery*; D001943:Breast Neoplasms / Q000532:radiotherapy / Q000601:surgery; D015331:Cohort Studies; D003131:Combined Modality Therapy; D016371:Cranial Irradiation / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000532:radiotherapy / Q000601:surgery; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods*; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D012004:Rectal Neoplasms / Q000532:radiotherapy / Q000601:surgery; D012189:Retrospective Studies