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Comparative Study
. 2017 Jan 6;17(1):30.
doi: 10.1186/s12885-016-2989-3.

A matched-pair study comparing whole-brain irradiation alone to radiosurgery or fractionated stereotactic radiotherapy alone in patients irradiated for up to three brain metastases

Dirk Rades  1 , Stefan Janssen  2   3 , Liesa Dziggel  2 , Oliver Blanck  4 , Amira Bajrovic  5 , Theo Veninga  6 , Steven E Schild  7
Affiliations
Comparative Study

A matched-pair study comparing whole-brain irradiation alone to radiosurgery or fractionated stereotactic radiotherapy alone in patients irradiated for up to three brain metastases

Dirk Rades et al. BMC Cancer. .

Abstract

Background: This matched-pair study was initiated to validate the results of a retrospective study of 186 patients published in 2007 that compared whole-brain irradiation (WBI) alone and radiosurgery (RS) alone for up to three brain metastases.

Methods: One-hundred-fifty-two patients receiving WBI alone for up to three brain metastases were matched with 152 patients treated with RS of fractionated stereotactic radiotherapy (FSRT) alone 1:1 for each of eight factors (age, gender, Eastern Oncology Cooperative Group (ECOG)-performance score, nature of tumor, brain metastases number, extra-cerebral spread, period from cancer detection to irradiation of brain metastases, and recursive partitioning analysis (RPA)-class. Groups were analyzed regarding intracerebral control (IC) and overall survival (OS).

Results: On univariate analysis of IC, type of irradiation did not significantly affect outcomes (p = 0.84). On Cox regression, brain metastases number (p < 0.001), nature of tumor (p < 0.001) and period from cancer detection to irradiation of brain metastases (p = 0.013) were significantly associated with IC. On univariate analysis of OS, type of irradiation showed no significant association with outcomes (p = 0.63). On multivariate analyses, OS was significantly associated with ECOG performance score (p = 0.011), nature of tumor (p = 0.035), brain metastases number (p = 0.048), extra-cerebral spread (p = 0.002) and RPA-class (p < 0.001).

Conclusion: In this matched-pair study, RS/FSRT alone was not superior to WBI alone regarding IC and OS. These results can be considered a revision of the findings from our retrospective previous study without matched-pair design, where RS alone resulted in significantly better IC than WBI alone on multivariate analysis.

Keywords: Intracerebral control; Matched-pair study; Metastases to the brain; Overall survival; Radiosurgery; Whole-brain irradiation.

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Figures

Fig. 1
Fig. 1
Comparison of whole-brain irradiation (WBI) alone and stereotactic radiosurgery (RS) or fractionated stereotactic radiotherapy (FSRT) alone with respect to intracerebral control (Kaplan-Meier curves)
Fig. 2
Fig. 2
Comparison of whole-brain irradiation (WBI) alone and stereotactic radiosurgery (RS) or fractionated stereotactic radiotherapy (FSRT) alone with respect to overall survival (Kaplan-Meier curves)
See this image and copyright information in PMC

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