Stereotactic Radiosurgery With or Without Whole-Brain Radiation Therapy for Limited Brain Metastases: A Secondary Analysis of the North Central Cancer Treatment Group N0574 (Alliance) Randomized Controlled Trial.

Autor:	Churilla TM; Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania., Ballman KV; Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota; Weill Medical College of Cornell University, New York, New York., Brown PD; Mayo Clinic, Rochester, Minnesota. Electronic address: Brown.Paul@mayo.edu., Twohy EL; Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota., Jaeckle K; Mayo Clinic, Jacksonville, Florida., Farace E; Penn State University College of Medicine, Hershey, Pennsylvania., Cerhan JH; Mayo Clinic, Rochester, Minnesota., Anderson SK; Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota., Carrero XW; Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota., Garces YI; Mayo Clinic, Rochester, Minnesota., Barker FG 2nd; Massachusetts General Hospital, Boston, Massachusetts., Deming R; Mercy Medical Center, Des Moines, Iowa., Dixon JG; Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota., Burri SH; Levine Cancer Institute, Carolinas Healthcare System, Charlotte, North Carolina., Chung C; University of Texas M. D. Anderson Cancer Center, Houston, Texas., Ménard C; Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada., Stieber VW; Novant Health Forsyth Medical Center, Winston-Salem, North Carolina., Pollock BE; Mayo Clinic, Rochester, Minnesota., Galanis E; Mayo Clinic, Rochester, Minnesota., Buckner JC; Mayo Clinic, Rochester, Minnesota., Asher AL; Levine Cancer Institute, Carolinas Healthcare System, Charlotte, North Carolina; Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina.
Jazyk:	angličtina
Zdroj:	International journal of radiation oncology, biology, physics [Int J Radiat Oncol Biol Phys] 2017 Dec 01; Vol. 99 (5), pp. 1173-1178. Date of Electronic Publication: 2017 Aug 05.
DOI:	10.1016/j.ijrobp.2017.07.045
Abstrakt:	Purpose: To determine whether whole-brain radiation therapy (WBRT) is associated with improved overall survival among non-small cell lung cancer (NSCLC) patients with favorable prognoses at diagnosis. Methods and Materials: In the N0574 trial, patients with 1 to 3 brain metastases were randomized to receive stereotactic radiosurgery (SRS) or SRS plus WBRT (SRS + WBRT), with a primary endpoint of cognitive deterioration. We calculated diagnosis-specific graded prognostic assessment (DS-GPA) scores for NSCLC patients and evaluated overall survival according to receipt of WBRT and DS-GPA score using 2 separate cut-points (≥2.0 vs <2.0 and ≥2.5 vs <2.5). Results: A total of 126 NSCLC patients were included for analysis, with median follow-up of 14.2 months. Data for DS-GPA calculation were available for 86.3% of all enrolled NSCLC patients. Overall, 50.0% of patients had DS-GPA score ≥2.0, and 23.0% of patients had DS-GPA scores ≥2.5. The SRS and SRS + WBRT groups were well balanced with regard to prognostic factors. The median survival according to receipt of WBRT was 11.3 months (+WBRT) and 17.9 months (-WBRT) for patients with DS-GPA ≥2.0 (favorable prognoses, P=.63; hazard ratio 0.86; 95% confidence interval 0.47-1.59). Median survival was 3.7 months (+WBRT) and 6.6 months (-WBRT) for patients with DS-GPA <2.0 patients (unfavorable prognoses, P=.85; hazard ratio 0.95; 95% confidence interval 0.56-1.62). Outcomes according to the receipt of WBRT and DS-GPA remained similar utilizing DS-GPA ≥2.5 as a cutoff for favorable prognoses. There was no interaction between the continuum of the DS-GPA groups and WBRT on overall survival (P=.53). Conclusions: We observed no significant differences in survival according to receipt of WBRT in favorable-prognosis NSCLC patients. This study further supports the approach of SRS alone in the majority of patients with limited brain metastases. (Copyright © 2017 Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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