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Comparative Study
. 2016 Jul 1;122(13):2091-100.
doi: 10.1002/cncr.30009. Epub 2016 Apr 18.

Comparative effectiveness of stereotactic radiosurgery versus whole-brain radiation therapy for patients with brain metastases from breast or non-small cell lung cancer

Lia M Halasz  1 , Hajime Uno  2 , Melissa Hughes  2 , Thomas D'Amico  3 , Elisabeth U Dexter  4   5 , Stephen B Edge  4   5 , James A Hayman  6 , Joyce C Niland  7 , Gregory A Otterson  8 , Katherine M W Pisters  9 , Richard Theriault  9 , Jane C Weeks  2 , Rinaa S Punglia  10
Affiliations
Comparative Study

Comparative effectiveness of stereotactic radiosurgery versus whole-brain radiation therapy for patients with brain metastases from breast or non-small cell lung cancer

Lia M Halasz et al. 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.

Keywords: breast neoplasms; comparative effectiveness research; neoplasm metastasis; non-small cell lung carcinoma; radiosurgery.

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Conflict of interest statement

Conflict of interest: Dr. D'Amico reports a consulting and advisory role for SCANLAN outside the submitted work. Drs. Dexter and Theriault report royalties from UpToDate outside the submitted work.

Figures

Figure 1
Figure 1
Distribution of propensity score by treatment, whole brain radiation therapy (WBRT) versus stereotactic radiosurgery (SRS) in patients with brain metastases from (a) non-small cell lung cancer (n = 180) and (b) breast cancer (n = 112). The black bars represent the number of WBRT patients and the grey bars represent the number of SRS patients. The propensity score for SRS is the probability given baseline variables that any patient in either group would be selected for SRS.
Figure 1
Figure 1
Distribution of propensity score by treatment, whole brain radiation therapy (WBRT) versus stereotactic radiosurgery (SRS) in patients with brain metastases from (a) non-small cell lung cancer (n = 180) and (b) breast cancer (n = 112). The black bars represent the number of WBRT patients and the grey bars represent the number of SRS patients. The propensity score for SRS is the probability given baseline variables that any patient in either group would be selected for SRS.
Figure 2
Figure 2
Unadjusted survival curves for (a) non-small cell lung cancer (n = 189) and (b) breast cancer (N=117). Survival curves adjusted by standardized mortality ratio for (c) non-small cell lung cancer (N=180) and (d) breast cancer (N=112).
Figure 2
Figure 2
Unadjusted survival curves for (a) non-small cell lung cancer (n = 189) and (b) breast cancer (N=117). Survival curves adjusted by standardized mortality ratio for (c) non-small cell lung cancer (N=180) and (d) breast cancer (N=112).
Figure 2
Figure 2
Unadjusted survival curves for (a) non-small cell lung cancer (n = 189) and (b) breast cancer (N=117). Survival curves adjusted by standardized mortality ratio for (c) non-small cell lung cancer (N=180) and (d) breast cancer (N=112).
Figure 2
Figure 2
Unadjusted survival curves for (a) non-small cell lung cancer (n = 189) and (b) breast cancer (N=117). Survival curves adjusted by standardized mortality ratio for (c) non-small cell lung cancer (N=180) and (d) breast cancer (N=112).
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