A meta-analysis evaluating stereotactic radiosurgery, whole-brain radiotherapy, or both for patients presenting with a limited number of brain metastases

Cancer. 2012 May 1;118(9):2486-93. doi: 10.1002/cncr.26515. Epub 2011 Sep 1.

Abstract

Background: To perform a meta-analysis on newly diagnosed brain metastases patients treated with whole-brain radiotherapy (WBRT) and stereotactic radiosurgery (SRS) boost versus WBRT alone, or in patients treated with SRS alone versus WBRT and SRS boost.

Methods: The meta-analysis primary outcomes were overall survival (OS), local control (LC), and distant brain control (DBC). Secondary outcomes were neurocognition, quality of life (QOL), and toxicity. Using published Kaplan-Meier curves, results were pooled using hazard ratios (HR).

Results: Two RCTs reported on WBRT and SRS boost versus WBRT alone. For multiple brain metastases (2-4 tumors) we conclude no difference in OS, and LC significantly favored WBRT plus SRS boost. Three RCTs reported on SRS alone versus WBRT plus SRS boost (1-4 tumors). There was no difference in OS despite both LC and DBC significantly favoring WBRT plus SRS boost. Although secondary endpoints could not be pooled for meta-analysis, those RCTs evaluating SRS alone conclude better neurocognition using the validated Hopkins Verbal Learning Test, no adverse risk in deteriorating Mini-Mental Status Exam scores or in maintaining performance status, and fewer late toxicities. We conclude insufficient data for QOL outcomes.

Conclusions: For selected patients, we conclude no OS benefit for WBRT plus SRS boost compared with SRS alone. Although additional WBRT improves DBC and LC, SRS alone should be considered a routine treatment option due to favorable neurocognitive outcomes, less risk of late side effects, and does not adversely affect the patients performance status.

Publication types

  • Meta-Analysis

MeSH terms

  • Brain Neoplasms / radiotherapy*
  • Brain Neoplasms / secondary*
  • Brain Neoplasms / surgery*
  • Cognition / radiation effects
  • Combined Modality Therapy
  • Humans
  • Quality of Life
  • Radiosurgery / adverse effects
  • Radiosurgery / methods*
  • Treatment Outcome