title: Management of brain metastases with stereotactic radiosurgery alone versus whole brain irradiation alone versus both.
abstract: BACKGROUND
  This prospective randomized study aimed to evaluate the role of WBRT + SRS compared to SRS alone and to WBRT alone in improvement of overall survival, brain local control and neurologic manifestations.
  
  
  METHODS
  The trial included 60 patients with 1 to 3 brain metastases treated at the Radiotherapy Department, National Cancer Institute. 21 patients received WBRT + SRS, 18 patients received SRS alone and 21 patients received WBRT alone.
  
  
  RESULTS
  Median local control was significantly better for WBRT + SRS compared to SRS alone & WBRT alone (10 vs 6 vs 5 months, respectively, P = 0.04). There was non significant survival benefit for WBRT + SRS compared to SRS alone & WBRT alone. Survival was significantly better for patients with controlled primary tumor who received WBRT + SRS compared to SRS alone & WBRT alone (median survival was 12 vs 5.5 vs 8 months, respectively. P = 0.027). Regardless of the treatment group, median survival and median local control were highly significantly better for single brain site involvement compared to multiple brain sites involvement (P = 0.003 & P = 0.001, respectively), and median brain local control was significantly better for single lesion compared to multiple lesions (P = 0.05).
  
  
  CONCLUSIONS
  WBRT + SRS is an effective, safe tool in treatment of patients with 1 to 3 brain metastses improving the brain local control, but further studies with larger number of patients is recommended.
authors.forename: Mahmoud M
authors.initials: MM
authors.lastname: El Gantery
authors.affiliation: The Department of Radiation Oncology, National Cancer Institute, Cairo University, Cairo, Egypt. hoda_elbakry@yahoo.com.
authors.forename: Hoda M
authors.initials: HM
authors.lastname: Abd El Baky
authors.forename: Hesham A
authors.initials: HA
authors.lastname: El Hossieny
authors.forename: Mohamed
authors.initials: M
authors.lastname: Mahmoud
authors.forename: Osama
authors.initials: O
authors.lastname: Youssef
mesh_terms: D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D019468:Disease Management; D005500:Follow-Up Studies; D006801:Humans; D009367:Neoplasm Staging; D011379:Prognosis; D016634:Radiosurgery; D015996:Survival Rate