title: Intracranial control and radiographic changes with adjuvant radiation therapy for resected brain metastases: whole brain radiotherapy versus stereotactic radiosurgery alone.
abstract: The aim of this study was to compare outcomes of postoperative whole brain radiation therapy (WBRT) to stereotactic radiosurgery (SRS) alone in patients with resected brain metastases (BM). We reviewed records of patients who underwent surgical resection of BM followed by WBRT or SRS alone between 2003 and 2013. Local control (LC) of the treated resected cavity, distant brain control (DBC), leptomeningeal disease (LMD), overall survival (OS), and radiographic leukoencephalopathy rates were estimated by the Kaplan-Meier method. One-hundred thirty-two patients underwent surgical resection for 141 intracranial metastases: 36 (27 %) patients received adjuvant WBRT and 96 (73 %) received SRS alone to the resection cavity. One-year OS (56 vs. 55 %, p = 0.64) and LC (83 vs. 74 %, p = 0.31) were similar between patients receiving WBRT and SRS. After controlling for number of BM, WBRT was associated with higher 1-year DBC compared with SRS (70 vs. 48 %, p = 0.03); single metastasis and WBRT were the only significant predictors for reduced distant brain recurrence in multi-variate analysis. Freedom from LMD was higher with WBRT at 18 months (87 vs. 69 %, p = 0.045), while incidence of radiographic leukoencephalopathy was higher with WBRT at 12 months (47 vs. 7 %, p = 0.001). One-year freedom from WBRT in the SRS alone group was 86 %. Compared with WBRT for patients with resected BM, SRS alone demonstrated similar LC, higher rates of LMD and inferior DBC, after controlling for the number of BM. However, OS was similar between groups. The results of ongoing clinical trials are needed to confirm these findings.
authors.affiliation: Department of Radiation Oncology and Winship Cancer Institute, Emory University, 1365 Clifton Rd NE, Room AT-225, Atlanta, GA, 30322, USA, kirtesh.patel@emory.edu.
authors.forename: Kirtesh R
authors.initials: KR
authors.lastname: Patel
authors.forename: Roshan S
authors.initials: RS
authors.lastname: Prabhu
authors.forename: Shravan
authors.initials: S
authors.lastname: Kandula
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Oliver
authors.forename: Sungjin
authors.initials: S
authors.lastname: Kim
authors.forename: Constantinos
authors.initials: C
authors.lastname: Hadjipanayis
authors.forename: Jeffery J
authors.initials: JJ
authors.lastname: Olson
authors.forename: Nelson
authors.initials: N
authors.lastname: Oyesiku
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Curran
authors.forename: Mohammad K
authors.initials: MK
authors.lastname: Khan
authors.forename: Hui-Kuo
authors.initials: HK
authors.lastname: Shu
authors.forename: Ian
authors.initials: I
authors.lastname: Crocker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000528:radiation effects / Q000601:surgery; D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000556:secondary / Q000601:surgery*; D016371:Cranial Irradiation / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D016634:Radiosurgery / Q000009:adverse effects / Q000379:methods*; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects / Q000379:methods*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult