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Resection plus whole-brain irradiation versus resection plus whole-brain irradiation plus boost for the treatment of single brain metastasis

Operation plus Ganzhirnbestrahlung versus Operation plus Ganzhirnbestrahlung plus Boost bei der Behandlung singulärer Hirnmetastasen

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Abstract

Background

The optimal treatment for patients with a single brain metastasis is controversial. This study investigated the value of a radiation boost given in addition to neurosurgerical resection and whole-brain irradiation (WBI).

Patients and methods

In this retrospective study, outcome data of 105 patients with a single brain metastasis receiving metastatic surgery plus WBI (S + WBI) were compared to 90 patients receiving the same treatment plus a boost to the metastatic site (S + WBI + B). The outcomes that were compared included local control of the resected metastasis (LC) and overall survival (OS). In addition to the treatment regimen, eight potential prognostic factors were evaluated including age, gender, performance status, extent of metastatic resection, primary tumor type, extracerebral metastases, recursive partitioning analysis (RPA) class, and interval from first diagnosis of cancer to metastatic surgery.

Results

The LC rates at 1 year, 2 years, and 3 years were 38%, 20%, and 9%, respectively, after S + WBI, and 67%, 51%, and 33%, respectively, after S + WBI + B (p = 0.002). The OS rates at 1 year, 2 years, and 3 years were 52%, 25%, and 19%, respectively, after S + WBI, and 60%, 40%, and 26%, respectively, after S + WBI + B (p = 0.11). On multivariate analyses, improved LC was significantly associated with OP + WBI + B (p = 0.006) and total resection of the metastasis (p = 0.014). Improved OS was significantly associated with age ≤ 60 years (p = 0.028), Karnofsky Performance Score > 70 (p = 0.015), breast cancer (p = 0.041), RPA class 1 (p = 0.012), and almost with the absence of extracerebral metastases (p = 0.05).

Conclusion

A boost in addition to WBI significantly improved LC but not OS following resection of a single brain metastasis.

Zusammenfassung

Hintergrund

Die optimale Therapie von Patienten mit einer singulären Hirnmetastase ist nicht hinreichend geklärt. In dieser Studie wurde der Effekt eines zusätzlichen Boosts der Metastasenregion nach Operation (S) plus Ganzhirnbestrahlung (WBI) untersucht.

Patienten und Methoden

In dieser retrospektiven Analyse wurden 105 Patienten mit einer singulären Hirnmetastase, die eine Operation plus WBI (S + WBI) erhalten hatten, mit 90 Patienten, die eine Operation plus WBI plus einen Boost der Metastasenregion (S + WBI + B) erhalten hatten, für die lokale Kontrolle der resezierten Metastase (LC) und das Gesamtüberleben (OS) verglichen. Zusätzlich wurden 8 weitere mögliche Prognosefaktoren untersucht: Alter, Geschlecht, Allgemeinzustand, Resektionsstatus, Art des Primärtumors, extrazerebrale Metastasen, RPA-Klasse („recursive partitioning analysis“) sowie das Zeitintervall von der Erstdiagnose der Tumorerkrankung bis zur Metastasenresektion.

Ergebnisse

Die Raten für die LC nach einem Jahr, nach 2 und nach 3 Jahren betrugen 38%, 20% und 9% nach S + WBI sowie 67%, 51% und 33% nach S + WBI + B (p = 0,002). Die Raten für das OS nach einem Jahr, nach 2 und 3 Jahren betrugen 52%, 25% und 19% nach S + WBI sowie 60%, 40% und 26% nach S + WBI + B (p = 0,11). In der Multivarianzanalyse war eine bessere LC signifikant mit OP + WBI + B (p = 0,006) und kompletter Metastasenentfernung (p = 0,014) assoziiert. Ein besseres OS war signifikant mit einem Alter  ≤ 60 Jahren (p = 0,028), einem Karnofsky-Index  > 70 (p = 0,015), einem Mammakarzinom als Primärtumor (p = 0,041), einer RPA-Klasse 1 (p = 0,012) und fast signifikant mit dem Nichtvorhandensein extrazerebraler Metastasen (p = 0,05) assoziiert.

Schlussfolgerungen

Bei der Behandlung einer singulären Hirnmetastase verbessert ein zusätzlicher Boost nach der Operation und WBI die lokale Kontrolle, nicht aber das Gesamtüberleben.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Lubeck, Ratzeburger Allee 160, 23538, Lubeck, Germany

    D. Rades M.D. & J.D. Kueter

  2. Department of Neurosurgery, University of Lubeck, Lubeck, Germany

    J. Gliemroth

  3. Department of Radiotherapy, Dr. Bernard Verbeeten Institute, Tilburg, Netherlands

    T. Veninga

  4. Department of Radiation Oncology, University of Hamburg, Hamburg, Germany

    A. Pluemer

  5. Department of Radiation Oncology, Mayo Clinic Scottsdale, Scottsdale, AZ, U.S.A.

    S.E. Schild

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  1. D. Rades M.D.
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  2. J.D. Kueter
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  3. J. Gliemroth
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  4. T. Veninga
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  5. A. Pluemer
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Correspondence to D. Rades M.D..

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Rades, D., Kueter, J., Gliemroth, J. et al. Resection plus whole-brain irradiation versus resection plus whole-brain irradiation plus boost for the treatment of single brain metastasis. Strahlenther Onkol 188, 143–147 (2012). https://doi.org/10.1007/s00066-011-0024-9

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  • DOI: https://doi.org/10.1007/s00066-011-0024-9

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