Stereotactic Radiosurgery with or without Whole Brain Radiotherapy for Limited Brain Metastases: A Secondary Analysis of the NCCTG N0574 (Alliance) Randomized Controlled Trial

Publication date: Available online 5 August 2017
Source:International Journal of Radiation Oncology*Biology*Physics
Author(s): Thomas M. Churilla, Karla V. Ballman, Paul D. Brown, Erin L. Twohy, Kurt Jaeckle, Elana Farace, Jane H. Cerhan, S. Keith Anderson, Xiomara W. Carrero, Yolanda I. Garces, Fred G. Barker, Richard Deming, Jesse G. Dixon, Stuart H. Burri, Caroline Chung, Cynthia Ménard, Volker W. Stieber, Bruce E. Pollock, Evanthia Galanis, Jan C. Buckner, Anthony L. Asher
BackgroundThere are conflicting data regarding a potential survival benefit to adjuvant whole brain radiotherapy (WBRT) among patients with limited brain metastases treated with stereotactic radiosurgery (SRS). We sought to determine if WBRT is associated with improved overall survival among non-small cell lung cancer (NSCLC) patients with favorable prognoses at diagnosis.MethodsIn the N0574 trial, patients with 1-3 brain metastases were randomized to receive SRS or SRS+WBRT with a primary endpoint of cognitive deterioration. We calculated diagnosis-specific graded prognostic assessment (DS-GPA) scores for NSCLC patients and evaluated overall survival according to receipt of WBRT and DS-GPA score using two separate cut-points (> 2.0 vs. <2.0 and > 2.5 vs. < 2.5).ResultsA total of 126 NSCLC patients were included for analysis with median follow up of 14.2 months. Data for DS-GPA calculation was available for 86.3% of all enrolled NSCLC patients. Overall, 50.0% of patients had DS-GPA score > 2.0 and 23.0% of patients had DS-GPA scores > 2.5. The SRS and SRS+WBRT groups were well balanced with regard to prognostic factors. The median survival according to receipt of WBRT was 11.3 months (+WBRT) and 17.9 months (-WBRT) for patients with DS-GPA > 2.0 (favorable prognoses, p=0.63; HR, 0.86; 95%CI, 0.47-1.59). Median survival was 3.7 months (+WBRT) and 6.6 months (-WBRT) for patients with DS-GPA < 2.0 patients (unfavorable prognoses, p=0.85; HR, 0.95; 95%CI, 0.56-1.62). Outcomes according to the receipt of WBRT and DS-GPA remained similar utilizing DS-GPA > 2.5 as a cutoff for favorable prognoses. There was no interaction between the continuum of the DS-GPA groups and WBRT on overall survival (p=0.53).ConclusionsWe observed no significant differences in survival according to receipt of WBRT in favorable prognosis NSCLC patients. This study further supports the approach of SRS alone in the majority of patients with limited brain metastases.

Teaser

There are conflicting data regarding whether adjuvant whole brain radiotherapy (WBRT) improves survival among patients with 1-3 brain metastases and favorable prognostic factors. Our post-hoc analysis of the N0574 trial demonstrated that overall survival did not differ according to the use of WBRT among non-small cell lung cancer patients with favorable (p=0.63) or unfavorable (p=0.85) diagnosis-specific graded prognostic assessment scores. In patients with limited (1-3) brain metastases, stereotactic radiosurgery alone remains a preferred treatment approach.


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