title: Comparative effectiveness of stereotactic radiosurgery versus whole-brain radiation therapy for patients with brain metastases from breast or non-small cell lung cancer.
abstract: BACKGROUND
  The optimal treatment for patients with brain metastases remains controversial as the use of stereotactic radiosurgery (SRS) alone, replacing whole-brain radiation therapy (WBRT), has increased. This study determined the patterns of care at multiple institutions before 2010 and examined whether or not survival was different between patients treated with SRS and patients treated with WBRT.
  
  
  METHODS
  This study examined the overall survival of patients treated with radiation therapy for brain metastases from non-small cell lung cancer (NSCLC; initially diagnosed in 2007-2009) or breast cancer (initially diagnosed in 1997-2009) at 5 centers. Propensity score analyses were performed to adjust for confounding factors such as the number of metastases, the extent of extracranial metastases, and the treatment center.
  
  
  RESULTS
  Overall, 27.8% of 400 NSCLC patients and 13.4% of 387 breast cancer patients underwent SRS alone for the treatment of brain metastases. Few patients with more than 3 brain metastases or lesions ≥ 4 cm in size underwent SRS. Patients with fewer than 4 brain metastases less than 4 cm in size (n = 189 for NSCLC and n = 117 for breast cancer) who were treated with SRS had longer survival (adjusted hazard ratio [HR] for NSCLC, 0.58; 95% confidence Interval [CI], 0.38-0.87; P = .01; adjusted HR for breast cancer, 0.54; 95% CI, 0.33-0.91; P = .02) than those treated with WBRT.
  
  
  CONCLUSIONS
  Patients treated for fewer than 4 brain metastases from NSCLC or breast cancer with SRS alone had longer survival than those treated with WBRT in this multi-institutional, retrospective study, even after adjustments for the propensity to undergo SRS. Cancer 2016;122:2091-100. © 2016 American Cancer Society.
authors.affiliation: Department of Radiation Oncology, University of Washington, Seattle, Washington.
authors.forename: Lia M
authors.initials: LM
authors.lastname: Halasz
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Hajime
authors.initials: H
authors.lastname: Uno
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Melissa
authors.initials: M
authors.lastname: Hughes
authors.affiliation: Department of Surgery, Duke Cancer Institute, Durham, North Carolina.
authors.forename: Thomas
authors.initials: T
authors.lastname: D'Amico
authors.affiliation: Department of Surgery, Roswell Park Cancer Institute, Buffalo, New York.|University of Buffalo, Buffalo, New York.
authors.forename: Elisabeth U
authors.initials: EU
authors.lastname: Dexter
authors.affiliation: Department of Surgery, Roswell Park Cancer Institute, Buffalo, New York.|University of Buffalo, Buffalo, New York.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Edge
authors.affiliation: University of Michigan, Ann Arbor, Michigan.
authors.forename: James A
authors.initials: JA
authors.lastname: Hayman
authors.affiliation: Information Sciences, City of Hope, Duarte, California.
authors.forename: Joyce C
authors.initials: JC
authors.lastname: Niland
authors.affiliation: Department of Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, Ohio.
authors.forename: Gregory A
authors.initials: GA
authors.lastname: Otterson
authors.affiliation: Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Katherine M W
authors.initials: KM
authors.lastname: Pisters
authors.affiliation: Department of Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
authors.forename: Richard
authors.initials: R
authors.lastname: Theriault
authors.affiliation: Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Jane C
authors.initials: JC
authors.lastname: Weeks
authors.affiliation: Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.
authors.forename: Rinaa S
authors.initials: RS
authors.lastname: Punglia
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D001943:Breast Neoplasms / Q000532:radiotherapy*; D002289:Carcinoma, Non-Small-Cell Lung / Q000532:radiotherapy*; D016371:Cranial Irradiation / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D016634:Radiosurgery / Q000706:statistics & numerical data*; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: breast neoplasms; comparative effectiveness research; neoplasm metastasis; non-small cell lung carcinoma; radiosurgery