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Whole-Brain Radiotherapy Combined with Surgery or Stereotactic Radiotherapy in Patients with Brain Oligometastases

Long-Term Analysis

Ganzhirnbestrahlung kombiniert mit operativer Entfernung oder stereotaktischer Strahlenbehandlung bei Patienten mit Oligohirnmetastasen: Eine Langzeitstudie

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Objective:

To verify whether the treatment of brain oligometastases with whole-brain radiotherapy (WBRT) plus stereotactic radiotherapy (SRT) or surgical resection results in different outcomes.

Methods:

Files of patients affected by brain metastases submitted to surgical resection followed by WBRT (group A) or WBRT + SRT (group B) were retrospectively selected for this study. The two treatment groups were matched for the following potential prognostic factors: WBRT schedule, age, gender, performance status, tumor type, number of brain metastases, extra-cerebral metastases, and recursive partitioning analysis class (RPA). The outcomes of patients in both groups were evaluated in terms of toxicity, local control, and overall survival.

Results:

Total of 97 patients were selected (56 male; 42 female) who were respectively submitted to surgical resection followed by WBRT (group A, n = 50 patients) or WBRT + SRT (Group B, n = 47 patients). Median follow-up was 95 months (range, 8–171 months). The 1-year local control rates were 46.0% and 69.0% respectively. No significant difference in local tumor control was observed between group A and B (p = 0.10). Median overall survival was 15 and 19 months in group A and B, respectively. One-year survival was 56.0% and 62%, respectively. No difference was observed in the two groups (p = 0.40).

Conclusion:

Surgery remains the main therapeutic approach in symptomatic patients; nevertheless, our data support the use of WBRT plus SRT in one or two brain metastases smaller than 3 cm.

Zielsetzung:

Zu untersuchen, ob die Behandlung von Oligohirnmetastasen mit Ganzhirnbestrahlung (whole-brain radiotherapy, WBRT) plus stereotaktischer Radiotherapie (SRT) oder chirurgischer Resektion unterschiedliche Ergebnisse bringt.

Methoden:

Krankenakten von Patienten mit operativ entfernten Hirnmetastasen und anschließender WBRT (Gruppe A) oder WBRT + SRT (Gruppe B) wurden retrospektiv für diese Studie ausgewählt. Die zwei Beghandlungsarme wurden für folgende prognostische Parameter gematcht: WBRT-Schema. Alter, Geschlecht, Allgemeinzustand, Art des Primärtumors, Anzahl der Hirnmetastasen, extrazerebrale Metastasen, Recursive-Partioning-Analysis-(RPA-)Klasse. Das Behandlungsergebnis für beide Patientengruppen wurde im Hinblick auf Toxizität, lokale Tumorkontrolle und Gesamtüberleben bewertet.

Ergebnisse:

Insgesamt wurden 97 Patienten ausgewählt (56 m; 42 w), die entweder mit operativer Entfernung und anschließender WBRT (Gruppe A, n = 50 Pat.) oder mit WBRT + SRT (Gruppe B, n = 47 Pat.) behandelt wurden. Die mediane Beobachtungszeit betrug 95 Monate (Spanne 8–171). Die lokale Tumorkontrolle nach 1 Jahr betrug 46,0% (Gruppe A) und 69,0% (Gruppe B), ohne dass dieser Unterschied statistisch signifikant wäre (p = 0,10). Das mediane Gesamtüberleben betrug jeweils 15 und 19 Monate in Gruppe A and B. Die 1-Jahres-Überlebensrate betrug jeweils 56,0% and 62%. Es wurde kein Unterschied zwischen den beiden Gruppen gefunden (p = 0,40).

Schlussfolgerung:

Die chirurgische Entfernung bleibt die Behandlungsoption bei symptomatischen Patienten. Unsere Daten sprechen für eine Behandlung mit WBRT plus SRT bei Vorliegen von ein oder zwei Hirnmetastasen, die kleiner als 3 cm sind.

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Authors and Affiliations

  1. Dept. of Radiation Oncology, Catholic University of the Sacred Heart, Rome, Italy

    Giuseppe Roberto D’Agostino, Rosa Autorino MD, Maria Carmen De Santis, Stefania Manfrida, Giovanna Mantini, Vincenzo Frascino, Silvia Chiesa, Nicola Dinapoli, Alba Fiorentino, Vincenzo Valentini & Mario Balducci

  2. Dept. of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy

    Angelo Pompucci, Alessio Albanese & Carmelo Anile

  3. Dept. of Radiology, Catholic University of the Sacred Heart, Rome, Italy

    Giuseppe Di Lella

  4. Dept. of Physics, Catholic University of the Sacred Heart, Rome, Italy

    Luigi Azario

  5. Dept. of Radiation Oncology, Catholic University of the Sacred Heart, Largo A. Gemelli, 8, 00168, Rome, Italy

    Rosa Autorino MD

Authors
  1. Giuseppe Roberto D’Agostino
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  2. Rosa Autorino MD
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  3. Angelo Pompucci
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  4. Maria Carmen De Santis
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  13. Alba Fiorentino
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  14. Vincenzo Valentini
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  15. Carmelo Anile
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Correspondence to Rosa Autorino MD.

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D’Agostino, G.R., Autorino, R., Pompucci, A. et al. Whole-Brain Radiotherapy Combined with Surgery or Stereotactic Radiotherapy in Patients with Brain Oligometastases. Strahlenther Onkol 187, 421–425 (2011). https://doi.org/10.1007/s00066-011-2228-4

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  • DOI: https://doi.org/10.1007/s00066-011-2228-4

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