NEW YORK (Reuters Health) Sep 21 - If patients have a limited number of brain metastases, stereotactic radiosurgery alone is as good as whole-brain radiotherapy plus stereotactic radiosurgery in terms of overall survival -- with less risk of neurocognitive side effects.
That's the conclusion of a meta-analysis by a Canadian team, reported in Cancer online September 1.
When stereotactic radiosurgery (SRS) was developed it was first tested as a "boost" to whole-brain radiotherapy (WBRT) in this setting, and then SRS alone was tested versus WBRT plus SRS boost, according to coauthor Dr. Arjun Sahgal with Sunnybrook Health Sciences Center in Toronto and colleagues.
To compare these strategies in patients with up to four brain metastases, the team identified five randomized controlled trials -- two comparing WBRT alone versus WBRT and SRS boost, and three reporting on SRS alone versus WBRT and SRS boost.
Local tumor control significantly favored the combination of WBRT plus SRS, compared to WBRT alone (hazard ratio 2.88) or SRS alone (hazard ratio 2.61), the investigators found. The addition of WBRT to SRS also improved distant brain control with an HR of 2.15.
Despite this, overall survival was not significantly different for any of the treatment strategies, according to the report.
On the other hand, one study showed that declines in learning and memory function were more likely with WBRT and SRS boost than with SRS alone. Another showed that radiographic leukoencephalopathy occurred in 11% of patients treated with WBRT and SRS compared with 3% of those receiving SRS alone, Dr. Sahgal and colleagues note.
Based on their analysis, they conclude that SRS alone should be considered a routine treatment option due to favorable neurocognitive outcomes and less risk of late side effects, and because it does not adversely affect performance status.
That's the conclusion of a meta-analysis by a Canadian team, reported in Cancer online September 1.
When stereotactic radiosurgery (SRS) was developed it was first tested as a "boost" to whole-brain radiotherapy (WBRT) in this setting, and then SRS alone was tested versus WBRT plus SRS boost, according to coauthor Dr. Arjun Sahgal with Sunnybrook Health Sciences Center in Toronto and colleagues.
To compare these strategies in patients with up to four brain metastases, the team identified five randomized controlled trials -- two comparing WBRT alone versus WBRT and SRS boost, and three reporting on SRS alone versus WBRT and SRS boost.
Local tumor control significantly favored the combination of WBRT plus SRS, compared to WBRT alone (hazard ratio 2.88) or SRS alone (hazard ratio 2.61), the investigators found. The addition of WBRT to SRS also improved distant brain control with an HR of 2.15.
Despite this, overall survival was not significantly different for any of the treatment strategies, according to the report.
On the other hand, one study showed that declines in learning and memory function were more likely with WBRT and SRS boost than with SRS alone. Another showed that radiographic leukoencephalopathy occurred in 11% of patients treated with WBRT and SRS compared with 3% of those receiving SRS alone, Dr. Sahgal and colleagues note.
Based on their analysis, they conclude that SRS alone should be considered a routine treatment option due to favorable neurocognitive outcomes and less risk of late side effects, and because it does not adversely affect performance status.
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