A Matched-Pair Analysis Comparing Whole-Brain Radiotherapy Plus Stereotactic Radiosurgery Versus Surgery Plus Whole-Brain Radiotherapy and a Boost to the Metastatic Site for One or Two Brain Metastases
| Autor: | Jan Dirk Kueter, Dirk Rades, Andre Pluemer, Theo Veninga, Steven E. Schild |
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| Rok vydání: | 2009 |
| Předmět: |
Male
Cancer Research Matched Pair Analysis medicine.medical_specialty Matched-Pair Analysis medicine.medical_treatment Treatment outcome Recursive partitioning Radiosurgery law.invention Randomized controlled trial law medicine Humans Radiology Nuclear Medicine and imaging Retrospective Studies Analysis of Variance Radiation Performance status Brain Neoplasms business.industry Radiotherapy Dosage Retrospective cohort study Middle Aged Combined Modality Therapy Surgery Radiation therapy Treatment Outcome Oncology Female Cranial Irradiation business |
| Zdroj: | International Journal of Radiation Oncology*Biology*Physics. 73:1077-1081 |
| ISSN: | 0360-3016 |
| DOI: | 10.1016/j.ijrobp.2008.05.035 |
| Popis: | Purpose To compare the results of whole-brain radiotherapy plus stereotactic radiosurgery (WBRT+SRS) with those of surgery plus whole-brain radiotherapy and a boost to the metastatic site (OP+WBRT+boost) for patients with one or two brain metastases. Methods and Materials Survival, intracerebral control, and local control of the treated metastases were retrospectively evaluated. To reduce the risk of selection bias, a matched-pair analysis was performed. The outcomes of 47 patients who received WBRT+SRS were compared with those of a second cohort of 47 patients who recieved OP+WBRT+boost. The two treatment groups were matched for the following potential prognostic factors: WBRT schedule, age, gender, performance status, tumor type, number of brain metastases, extracerebral metastases, recursive partitioning analysis class, and interval from tumor diagnosis to WBRT. Results The 1-year survival rates were 65% after WBRT+SRS and 63% after OP+WBRT+boost ( p = 0.19). The 1-year intracerebral control rates were 70% and 78% ( p = 0.39), respectively. The 1-year local control rates were 84% and 83% ( p = 0.87), respectively. On multivariate analyses, improved survival was significantly associated with better performance status ( p = 0.009), no extracerebral metastases ( p = 0.004), recursive partitioning analysis Class 1 ( p = 0.004), and interval from tumor diagnosis to WBRT ( p = 0.001). Intracerebral control was not significantly associated with any of the potential prognostic factors. Improved local control was significantly associated with no extracerebral metastases ( p = 0.037). Conclusions Treatment outcomes were not significantly different after WBRT+SRS compared with OP+WBRT+boost. However, WBRT+SRS is less invasive than OP+WBRT+boost and may be preferable for patients with one or two brain metastases. The results should be confirmed by randomized trials. |
| Databáze: | OpenAIRE |
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