Preliminary Report of RTOG 9508: A Phase III Trial Comparing Whole Brain Irradiation Alone Versus Whole Brain Irradiation Plus Stereotactic Radiosurgery for Patients with Two or Three Unresected Brain Metastases

English

Joel W. Goldwein, MD
OncoLink co-Editor-In-Chief
Ultima Vez Modificado: 23 de octubre del 2000

Presenter: P. W. Sperduto
Affiliation: Radiation Therapy Oncology Group

Summary:

Brain metastases develop in approximately 25% of all cancer patients. Management with stereotactic radiotherapy for patients with 3 or less solitary lesions remains an area of controversy. This preliminary analysis is of a group of patients treated with whole brain radiation versus whole brain radiotherapy plus a radiosurgical boost.

Methods:

Patients with 2 or 3 solitary metastases were evaluated in this analysis
Patients were randomized to either 3750 cGy/15 fractions whole brain RT or 3750 cGy/15 fractions whole brain RT + 1500 cGy to 2400 cGy radiosurgical boost (size dependent)

Results:

The groups were well balanced for parameters such as KPS, numbers of lesions, and other factors
Median survival in the 2 arms were 5.8 and 6.7 months, and were not significantly different.
Local control was marginally better in the stereotactic boost arm vs. the whole brain alone arm
There was a 20% improvement in Karnofsky status in the radiosurgery arm versus 0% in the whole brain alone arm, and a similar reduction in steroid dependence among patients receiving boost RT.
There was no grade 4 or 5 toxicity in either arm, and 4% grade III toxicity in the boost arm versus 0% in the no-boost arm

Author's Conclusions:

In patients with 2 or 3 brain metastases, stereotactic boost following whole brain RT has no impact on survival, improves local control, and may improve quality of life

Clinical/Scientific Implications:

Patients with 2 or 3 brain metastases may benefit from such therapy in terms of local control and quality of life
Further study will be required to identify subsets of patients who derive the most benefit from this therapy.