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Intracranial control and radiographic changes with adjuvant radiation therapy for resected brain metastases: whole brain radiotherapy versus stereotactic radiosurgery alone

Journal of Neuro-Oncology volume 120, pages 657–663 (2014)Cite this article

Abstract

The aim of this study was to compare outcomes of postoperative whole brain radiation therapy (WBRT) to stereotactic radiosurgery (SRS) alone in patients with resected brain metastases (BM). We reviewed records of patients who underwent surgical resection of BM followed by WBRT or SRS alone between 2003 and 2013. Local control (LC) of the treated resected cavity, distant brain control (DBC), leptomeningeal disease (LMD), overall survival (OS), and radiographic leukoencephalopathy rates were estimated by the Kaplan–Meier method. One-hundred thirty-two patients underwent surgical resection for 141 intracranial metastases: 36 (27 %) patients received adjuvant WBRT and 96 (73 %) received SRS alone to the resection cavity. One-year OS (56 vs. 55 %, p = 0.64) and LC (83 vs. 74 %, p = 0.31) were similar between patients receiving WBRT and SRS. After controlling for number of BM, WBRT was associated with higher 1-year DBC compared with SRS (70 vs. 48 %, p = 0.03); single metastasis and WBRT were the only significant predictors for reduced distant brain recurrence in multi-variate analysis. Freedom from LMD was higher with WBRT at 18 months (87 vs. 69 %, p = 0.045), while incidence of radiographic leukoencephalopathy was higher with WBRT at 12 months (47 vs. 7 %, p = 0.001). One-year freedom from WBRT in the SRS alone group was 86 %. Compared with WBRT for patients with resected BM, SRS alone demonstrated similar LC, higher rates of LMD and inferior DBC, after controlling for the number of BM. However, OS was similar between groups. The results of ongoing clinical trials are needed to confirm these findings.

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Conflict of interest

No conflicts of interest exist for any of the authors except Constantinos Hadjipanayis, MD, Consultant, Meditech Incorporated.

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Affiliations

  1. Department of Radiation Oncology and Winship Cancer Institute, Emory University, 1365 Clifton Rd NE, Room AT-225, Atlanta, GA, 30322, USA

    Kirtesh R. Patel, Shravan Kandula, Walter J. Curran, Mohammad K. Khan, Hui-Kuo Shu & Ian Crocker

  2. Southeast Radiation Oncology Group, Levine Cancer Institute, Emory University School of Medicine, Charlotte, NC, USA

    Roshan S. Prabhu

  3. Emory University School of Medicine, Atlanta, GA, USA

    Daniel E. Oliver

  4. Biostatistics and Bioinformatics Shared Resource, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Sungjin Kim

  5. Department of Neurological Surgery, Emory University, Atlanta, GA, USA

    Constantinos Hadjipanayis, Jeffery J. Olson & Nelson Oyesiku

Authors
  1. Kirtesh R. Patel
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  2. Roshan S. Prabhu
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  3. Shravan Kandula
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  4. Daniel E. Oliver
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  5. Sungjin Kim
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  6. Constantinos Hadjipanayis
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  7. Jeffery J. Olson
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  8. Nelson Oyesiku
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  9. Walter J. Curran
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  11. Hui-Kuo Shu
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  12. Ian Crocker
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Correspondence to Kirtesh R. Patel.

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Patel, K.R., Prabhu, R.S., Kandula, S. et al. Intracranial control and radiographic changes with adjuvant radiation therapy for resected brain metastases: whole brain radiotherapy versus stereotactic radiosurgery alone. J Neurooncol 120, 657–663 (2014). https://doi.org/10.1007/s11060-014-1601-4

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  • DOI: https://doi.org/10.1007/s11060-014-1601-4

Keywords

  • Brain metastases
  • Whole brain radiation therapy
  • Stereotactic radiosurgery
  • Frameless radiosurgery
  • Post-operative