Universität zu Köln

Sahgal, Arjun, Aoyama, Hidefumi ORCID: 0000-0002-8437-7491, Kocher, Martin, Neupane, Binod, Collette, Sandra, Tago, Masao, Shah, Prakesh, Beyene, Joseph and Chang, Eric L. (2015). Phase 3 Trials of Stereotactic Radiosurgery With or Without Whole-Brain Radiation Therapy for 1 to 4 Brain Metastases: Individual Patient Data Meta-Analysis. Int. J. Radiat. Oncol. Biol. Phys., 91 (4). S. 710 - 718. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1879-355X

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Abstract

Purpose: To perform an individual patient data (IPD) meta-analysis of randomized controlled trials evaluating stereotactic radiosurgery (SRS) with or without whole-brain radiation therapy (WBRT) for patients presenting with 1 to 4 brain metastases. Method and Materials: Three trials were identified through a literature search, and IPD were obtained. Outcomes of interest were survival, local failure, and distant brain failure. The treatment effect was estimated after adjustments for age, recursive partitioning analysis (RPA) score, number of brain metastases, and treatment arm. Results: A total of 364 of the pooled 389 patients met eligibility criteria, of whom 51% were treated with SRS alone and 49% were treated with SRS plus WBRT. For survival, age was a significant effect modifier (P=.04) favoring SRS alone in patients <= 50 years of age, and no significant differences were observed in older patients. Hazard ratios (HRs) for patients 35, 40, 45, and 50 years of age were 0.46 (95% confidence interval [CI] = 0.24-0.90), 0.52 (95% CI = 0.29-0.92), 0.58 (95% CI = 0.35-0.95), and 0.64 (95% CI = 0.42-0.99), respectively. Patients with a single metastasis had significantly better survival than those who had 2 to 4 metastases. For distant brain failure, age was a significant effect modifier (P=.043), with similar rates in the 2 arms for patients <= 50 of age; otherwise, the risk was reduced with WBRT for patients >50 years of age. Patients with a single metastasis also had a significantly lower risk of distant brain failure than patients who had 2 to 4 metastases. Local control significantly favored additional WBRT in all age groups. Conclusions: For patients <= 50 years of age, SRS alone favored survival, in addition, the initial omission of WBRT did not impact distant brain relapse rates. SRS alone may be the preferred treatment for this age group. (C) 2015 Elsevier Inc.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Sahgal, Arjun UNSPECIFIED UNSPECIFIED UNSPECIFIED Aoyama, Hidefumi UNSPECIFIED orcid.org/0000-0002-8437-7491 UNSPECIFIED Kocher, Martin UNSPECIFIED UNSPECIFIED UNSPECIFIED Neupane, Binod UNSPECIFIED UNSPECIFIED UNSPECIFIED Collette, Sandra UNSPECIFIED UNSPECIFIED UNSPECIFIED Tago, Masao UNSPECIFIED UNSPECIFIED UNSPECIFIED Shah, Prakesh UNSPECIFIED UNSPECIFIED UNSPECIFIED Beyene, Joseph UNSPECIFIED UNSPECIFIED UNSPECIFIED Chang, Eric L. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-404968
DOI:	10.1016/j.ijrobp.2014.10.024
Journal or Publication Title:	Int. J. Radiat. Oncol. Biol. Phys.
Volume:	91
Number:	4
Page Range:	S. 710 - 718
Date:	2015
Publisher:	ELSEVIER SCIENCE INC
Place of Publication:	NEW YORK
ISSN:	1879-355X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language SINGLE METASTASES; RANDOMIZED-TRIAL; RADIOTHERAPY; SURGERY; IRRADIATION; ERLOTINIB Multiple languages Oncology; Radiology, Nuclear Medicine & Medical Imaging Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/40496