title: Whole brain radiotherapy and stereotactic radiosurgery for patients with recursive partitioning analysis I and lesions <5 cm(3): A matched pair analysis.
abstract: OBJECTIVE
  The intention of this study is to compare whole brain radiotherapy and stereotactic radiosurgery (WBRT + SRS) with WBRT in patients with 1-4 brain metastases to find a subgroup of patients that have a great benefit with aggressive treatment.
  
  
  METHODS
  Between December 2002 and December 2013, 60 patients with 1-4 brain metastases were treated by WBRT + SRS. In this period, 60 patients treated with WBRT were matched with patients treated with WBRT + SRS.
  
  
  RESULTS
  The median survival for the entire cohort was 8.3 months. In the univariate analysis, WBRT + SRS (0.031), the presence of extracranial disease (P = 0.02), Karnofsky performance score <70 (P = 0.0001), and age >65 (P = 0.001) years were significant factors for survival. In the entire cohort, the median survival for recursive partitioning analysis (RPA) classes I, II, and III was 11, 7, and 3 months, respectively (P = 0.0001). In a stratified analysis, only RPA class I achieved statistical significance for 1-year survival between the groups (WBRT + SRS = 51% and WBRT = 23%, P = 0.03). Cox regression analysis revealed WBRT + SRS, age >65 years, and extracranial disease as independent prognostic factors. In the univariate analysis, lesion volume ≤5 cm 3 (P = 0.002) and WBRT + SRS (P = 0.003) were the significant factors associated with better brain control.
  
  
  CONCLUSIONS
  WBRT plus SRS was an independent prognostic factor for survival. However, the combined treatment appears to be justified only in patients with RPA I and lesion volume ≤5 cm 3, independently of the number of lesions.
authors.affiliation: Department of Radiation Oncology, Marilia Medical School, Marília, São Paulo, Brazil.
authors.forename: Gustavo Arruda
authors.initials: GA
authors.lastname: Viani
authors.affiliation: Department of Radiation Oncology, Marilia Medical School, Marília, São Paulo, Brazil.
authors.forename: Lucas Bernardes
authors.initials: LB
authors.lastname: Godoi da Silva
authors.affiliation: Department of Radiation Oncology, Marilia Medical School, Marília, São Paulo, Brazil.
authors.forename: Bruno Silveira
authors.initials: BS
authors.lastname: Viana
authors.affiliation: Department of Radiation Oncology, Marilia Medical School, Marília, São Paulo, Brazil.
authors.forename: Bruno Tiago
authors.initials: BT
authors.lastname: Rossi
authors.affiliation: Department of Radiation Oncology, Marilia Medical School, Marília, São Paulo, Brazil.
authors.forename: Elton
authors.initials: E
authors.lastname: Suguikawa
authors.affiliation: Department of Radiation Oncology, Marilia Medical School, Marília, São Paulo, Brazil.
authors.forename: Gisele
authors.initials: G
authors.lastname: Zuliani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000532:radiotherapy* / Q000556:secondary; D003131:Combined Modality Therapy; D016371:Cranial Irradiation / Q000379:methods; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D016634:Radiosurgery; D016896:Treatment Outcome; D047368:Tumor Burden