Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases - A randomized controlled trial

被引:1723
作者
Aoyama, Hidefumi
Shirato, Hiroki
Tago, Masao
Nakagawa, Keiichi
Toyoda, Tatsuya
Hatano, Kazuo
Kenjyo, Masahiro
Oya, Natsuo
Hirota, Saeko
Shioura, Hiroki
Kunieda, Etsuo
Inomata, Taisuke
Hayakawa, Kazushige
Katoh, Norio
Kobashi, Gen
机构
[1] Hokkaido Univ, Grad Sch Med, Dept Radiol, Kita Ku, Sapporo, Hokkaido 0608638, Japan
[2] Hokkaido Univ, Grad Sch Med, Dept Global Hlth & Epidemiol, Div Prevent Med, Sapporo, Hokkaido 0608638, Japan
[3] Tokyo Univ Hosp, Dept Radiol, Tokyo 113, Japan
[4] Kanto Med Ctr NTT EC, Dept Radiol, Tokyo, Japan
[5] Chiba Canc Ctr, Dept Radiol, Chiba, Japan
[6] Hiroshima Univ, Sch Med, Dept Radiol, Hiroshima, Japan
[7] Kyoto Univ, Sch Med, Dept Radiol, Kyoto 606, Japan
[8] Hyogo Med Ctr Adults, Dept Radiol, Akashi, Hyogo, Japan
[9] Izumisano Gen Hosp, Dept Radiol, Izumisano, Japan
[10] Keio Univ, Sch Med, Dept Radiol, Tokyo, Japan
[11] Osaka Med Coll, Dept Radiol, Osaka, Japan
[12] Kitazato Med Sch, Dept Radiol, Sagamihara, Kanagawa, Japan
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2006年 / 295卷 / 21期
关键词
D O I
10.1001/jama.295.21.2483
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context In patients with brain metastases, it is unclear whether adding up-front whole-brain radiation therapy (WBRT) to stereotactic radiosurgery (SRS) has beneficial effects on mortality or neurologic function compared with SRS alone. Objective To determine if WBRT combined with SRS results in improvements in survival, brain tumor control, functional preservation rate, and frequency of neurologic death. Design, Setting, and Patients Randomized controlled trial of 132 patients with 1 to 4 brain metastases, each less than 3 cm in diameter, enrolled at 11 hospitals in Japan between October 1999 and December 2003. Interventions Patients were randomly assigned to receive WBRT plus SRS ( 65 patients) or SRS alone ( 67 patients). Main Outcome Measures The primary end point was overall survival; secondary end points were brain tumor recurrence, salvage brain treatment, functional preservation, toxic effects of radiation, and cause of death. Results The median survival time and the 1-year actuarial survival rate were 7.5 months and 38.5% (95% confidence interval, 26.7%-50.3%) in the WBRT + SRS group and 8.0 months and 28.4% (95% confidence interval, 17.6%-39.2%) for SRS alone (P=. 42). The 12-month brain tumor recurrence rate was 46.8% in the WBRT + SRS group and 76.4% for SRS alone group ( P <. 001). Salvage brain treatment was less frequently required in the WBRT + SRS group (n = 10) than with SRS alone ( n = 29) ( P <. 001). Death was attributed to neurologic causes in 22.8% of patients in the WBRT + SRS group and in 19.3% of those treated with SRS alone ( P=. 64). There were no significant differences in systemic and neurologic functional preservation and toxic effects of radiation. Conclusions Compared with SRS alone, the use of WBRT plus SRS did not improve survival for patients with 1 to 4 brain metastases, but intracranial relapse occurred considerably more frequently in those who did not receive WBRT. Consequently, salvage treatment is frequently required when up-front WBRT is not used.
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收藏
页码:2483 / 2491
页数:9
相关论文
共 25 条
[1]   Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial [J].
Andrews, DW ;
Scott, CB ;
Sperduto, PW ;
Flanders, AE ;
Gaspar, LE ;
Schell, MC ;
Werner-Wasik, M ;
Demas, W ;
Ryu, J ;
Bahary, JP ;
Souhami, L ;
Rotman, M ;
Mehta, MP ;
Curran, WJ .
LANCET, 2004, 363 (9422) :1665-1672
[2]  
[Anonymous], RTOG EORTC LAT RAD M
[3]   Hypofractionated stereotactic radiotherapy alone without whole-brain irradiation for patients with solitary and oligo brain metastasis using noninvasive fixation of the skull [J].
Aoyama, HI ;
Shirato, H ;
Onimaru, R ;
Kagei, K ;
Ikeda, J ;
Ishii, N ;
Sawamura, Y ;
Miyasaka, K .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2003, 56 (03) :793-800
[4]   Management of brain metastases [J].
Bradley, KA ;
Mehta, MP .
SEMINARS IN ONCOLOGY, 2004, 31 (05) :693-701
[5]   Application of recursive partitioning analysis and evaluation of the use of whole brain radiation among patients treated with stereotactic radiosurgery for newly diagnosed brain metastases [J].
Chidel, MA ;
Suh, JH ;
Reddy, CA ;
Chao, ST ;
Lundbeck, MF ;
Barnett, GH .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 2000, 47 (04) :993-999
[6]  
COX DR, 1972, J R STAT SOC B, V34, P187
[7]   RADIATION-INDUCED DEMENTIA IN PATIENTS CURED OF BRAIN METASTASES [J].
DEANGELIS, LM ;
DELATTRE, JY ;
POSNER, JB .
NEUROLOGY, 1989, 39 (06) :789-796
[8]   A MULTIINSTITUTIONAL EXPERIENCE WITH STEREOTAXIC RADIOSURGERY FOR SOLITARY BRAIN METASTASIS [J].
FLICKINGER, JC ;
KONDZIOLKA, D ;
LUNSFORD, LD ;
COFFEY, RJ ;
GOODMAN, ML ;
SHAW, EG ;
HUDGINS, WR ;
WEINER, R ;
HARSH, GR ;
SNEED, PK ;
LARSON, DA .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 1994, 28 (04) :797-802
[9]   Recursive partitioning analysis (RPA) of prognostic factors in three radiation therapy oncology group (RTOG) brain metastases trials [J].
Gaspar, L ;
Scott, C ;
Rotman, M ;
Asbell, S ;
Phillips, T ;
Wasserman, T ;
McKenna, WG ;
Byhardt, R .
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS, 1997, 37 (04) :745-751
[10]   Linear accelerator-based stereotaxic radiosurgery for brain metastases: The influence of number of lesions on survival [J].
Joseph, J ;
Adler, JR ;
Cox, RS ;
Hancock, SL .
JOURNAL OF CLINICAL ONCOLOGY, 1996, 14 (04) :1085-1092