title: The role of whole-brain radiation therapy after stereotactic radiation surgery for brain metastases.
abstract: The benefit of whole-brain radiation therapy (WBRT) following stereotactic radiation surgery (SRS) for brain metastases is controversial. We conducted a systematic analysis of published literature to explore the outcome of brain metastases treated with SRS and WBRT versus SRS alone using PubMed and MEDLINE. Outcomes including survival, control, salvage therapy, and other quality of life measures were reported. Three randomized controlled trials involving 389 patients with 1 to 4 brain metastases were selected. In 2 of these trials (n = 190), the mean 1-year survival was 33.2% for SRS + WBRT and 38.7% for SRS alone (P = .5233); 1-year local control was 89% for SRS + WBRT and 71% for SRS alone (P < .001). Mean crude distant recurrence rate for SRS + WBRT was 36.6% and 54% for SRS alone (P < .001). Patients without WBRT were over 3 times more likely to require salvage therapy (P < .001). The addition of WBRT was associated with a decreased health-related quality of life assessment, mini mental status exam, and Hopkins Verbal Learning Test (P < .05). Five retrospective studies (n = 1122) were also included in a separate analysis and yielded findings that supported results from the randomized trials. Our systematic analysis demonstrates that adjuvant WBRT following SRS for the treatment of oligometastases in the brain is more effective at controlling local and distant recurrence than SRS alone, but there is no apparent benefit for survival or symptomology. The proven cognitive decline and neurotoxicity present with WBRT should be weighed against the benefit of local control. Prognosis of brain metastasis is poor regardless of current treatment and further exploration for alternative adjuvant treatment for SRS is warranted.
authors.affiliation: Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, Florida.
authors.forename: Shaakir
authors.initials: S
authors.lastname: Hasan
authors.affiliation: University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, Florida.
authors.forename: Ashish H
authors.initials: AH
authors.lastname: Shah
authors.affiliation: University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, Florida.
authors.forename: Amade
authors.initials: A
authors.lastname: Bregy
authors.affiliation: Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, Florida.
authors.forename: Trevine
authors.initials: T
authors.lastname: Albert
authors.affiliation: University of Miami Miller School of Medicine, Department of Radiation Oncology, Miami, Florida.
authors.forename: Arnold
authors.initials: A
authors.lastname: Markoe
authors.affiliation: University of Miami Miller School of Medicine, Department of Radiation Oncology, Miami, Florida.
authors.forename: Radka
authors.initials: R
authors.lastname: Stoyanova
authors.affiliation: University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, Florida.
authors.forename: Michael
authors.initials: M
authors.lastname: Thambuswamy
authors.affiliation: University of Miami Miller School of Medicine, Department of Neurological Surgery, Miami, Florida. Electronic address: rkomotar@med.miami.edu.
authors.forename: Ricardo J
authors.initials: RJ
authors.lastname: Komotar
mesh_terms: D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000601:surgery; D003131:Combined Modality Therapy; D016371:Cranial Irradiation / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015201:Meta-Analysis as Topic; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011788:Quality of Life; D016634:Radiosurgery / Q000401:mortality*; D018714:Radiotherapy, Adjuvant / Q000401:mortality*; D016879:Salvage Therapy; D015996:Survival Rate