Comparison of three treatment options for single brain metastasis from lung cancer

Abstract

SUMMARY Whole brain radiotherapy (WBRT), stereotactic radiosurgery (SRS), and the combination of both treatment methods were used for the management of single brain metastasis from lung cancer. The purpose of this study is to compare these three different treatment options in terms of local response, survival, and quality of life. From June 1995 to July 1998, 70 lung cancer patients with new diagnosed single brain metastasis were treated with either WBRT alone (n = 29), or SRS alone (n = 23), or the combination of both methods (n = 18). Multiple endpoints, including survival, freedom from local progression (FFLP), freedom from new brain metastasis (FFNBM), local control, Karnofsky performance status (KPS), and causes of death, were measured from the date of treatment completion and compared using univariate and multivariate analyses. For patients treated with WBRT-alone, SRS-alone, and SRS+WBRT, the median survivals were 5.7, 9.3, and 10.6 months, the median FFLP were 4.0, 6.9, and 8.6 months, the median FFNBM were 4.1, 6.7, and 8.6 months, and the local response rates were 55.6, 87.0, and 88.9%, respectively. Four of the 29 patients treated with WBRT-alone continued with progression of disease. The post treatment KPS showed improvement in 41.4, 82.6, and 88.9% of patients treated with WBRT-alone, SRS-alone, and SRS+WBRT, respectively. The progression of new and/or recurred metastatic brain tumor as the cause of death accounted for 51.7%, 50.0%, and 28.3% of the patients treated with WBRT-alone, SRS-alone, and SRS+WBRT, respectively. Univariate analyses showed that the significant differences among the three treatment arms were observed based on all of the above mentioned endpoints. However, the comparison between SRS-alone and SRS+WBRT groups indicated that adding WBRT only improves FFNBM (P = 0.0392). Cox regression analyses revealed no significant difference in both of the KPS (P = 0.1082) and causes of death (P = 0.081) among the three arms. Both SRS alone and SRS+WBRT seem better in prolonging life and improving quality of life than WBRT alone for patients with single brain metastasis from lung cancer. But the combined therapy did not show significant advantage over SRS alone in improving survival, enhancing local control, and quality of life except for a more favorable FFNBM. Further investigation via a randomized trial is needed to access the value of adding WBRT to SRS in the management of this group of patients. Int. J. Cancer (Radiat. Oncol. Invest.) 90, 37-45 (2000).

Management of brain metastases

“…The type of radiosurgical procedure, gammaknife or Linac-based, does not have an impact on overall survival [18,108]. Radiosurgery, alone or in conjunction with WBRT, has been reported to be superior to conventional WBRT alone in terms of local control, survival and quality of life [72]. This issue is currently being addressed by the RTOG study 9508, which is comparing in a phase III study WBRT with versus without stereotactic radiosurgery boost for patients with single brain metastasis.…”

“…Some retrospective studies [30,117] and one phase III study from USA [96] have reported that adjuvant WBRT after complete surgical resection significantly reduces local and distant CNS relapses (18 % with surgery + WBRT versus 70 % with surgery alone according to Patchell study), without affecting overall survival or functionally independent survival, except for a modest advantage in patients without evidence of extracranial disease. Similarly WBRT in conjunction with radiosurgery improves local control and reduces the risk of new distant brain metastases [24,47,72,103,116,118],but most studies support the viewpoint that combined radiosurgery and WBRT does not improve the overall survival [44,80,115,118], except for patients without evidence of extracranial disease [98]. WBRT may cause early adverse effects (fatigue, alopecia, eustachian tube dysfunction) and late neurotoxicity.…”

Solitary sites of metastatic disease in non-small cell lung cancer

“…However, the combined therapy did not show a statistically significant advantage over SRS alone in improving survival rates, local control, or the quality of life of patients. Further investigation through randomized trials is needed to assess the value of adding WBRT to SRS in the treatment of patients with single brain metastasis from NSCLC [30]. • SRS provides an effective option in the treatment of patients with metastatic NSCLC.…”

Surgical treatment of brain metastasis

“…Another study showed that SRS was superior to WBRT for treating a single brain metastasis. 29 Also, the effectiveness of an SRS boost after WBRT was confirmed by a randomized trial. 30 Most of the results obtained with SRS alone or in combination with other modalities have shown an approximate median survival time of 9 months or more, 29,31,32 which is comparable with, or superior to, that of WBRT or surgery followed by radiation treatment.…”