A recent study showed that patients with few brain metastases receiving only stereotactic radiosurgery (SRS) have improved survival when compared to SRS together with whole-brain radiation (WBRT). The study entitled “Phase 3 Trials of Stereotactic Radiosurgery With or Without Whole-Brain Radiation Therapy for 1 to 4 Brain Metastases: Individual Patient Data Meta-Analysis” was published in the International Journal of Radiation Oncology by Dr. Arjun Sahgal from the Department of Radiation Oncology, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada, and colleagues.
There has been a shift in the management of patients with a few number (1 to 4) of brain metastases from whole-brain radiation (WBRT) alone to a more aggressive strategy including stereotactic radiosurgery (SRS). Stereotactic radiosurgery is designed as a single dose of radiation delivered with high precision locally to a brain metastasis with the purpose of maximizing local control while avoiding normal brain tissue.
Until now there have been only 3 completed published randomized controlled trials (RCTs) comparing SRS alone with SRS together with whole-brain radiation (WBRT) in patients presenting 1 to 4 brain metastases were the primary endpoints were inconsistent and not designed for survival. The rationale of this study was to gather individual patient data (IPD) from 3 RCTs and conduct an IPD meta-analysis to evaluate the efficacy of SRS, with or without WBRT, for patients with 1 to 4 brain metastases with respect to survival, local failure, and distant brain failure.
The research team found that the influence of age on treatment efficiency showed that SRS alone gave a better overall survival (OS) in patients 50 years old and younger. These patients had a median survival of 13.6 months, a 65% progress, when compared with 8.2 months for patients with the same age treated with SRS together with WBRT. Patients older than 50 years had a median survival of 10.1 months when treated with SRS alone or 8.6 months when receiving SRS plus WBRT.
“Therefore, our sub-group meta-analysis has swung the pendulum in favor of SRS alone as the standard of care. These findings also reinforce ASTRO’s Choosing Wisely recommendation that states that it may not be necessary to add WBRT to SRS, thus improving patients’ quality of life and memory function.” said Dr. Arjun Sahgal in the news release.