gms | German Medical Science

Object: To assess whether outpatient radiosurgery alone is as effective as surgery and whole brain irradiation (WBRT) for survival and neurologic control of disease in patients with single metastases to the brain.

Methods: Sixty-four patients with a single metastasis with a diameter up to 3 cm were randomly assigned to either microsurgery followed by whole brain radiotherapy (surgical group, 33 patients) or radiosurgery alone (radiosugery group, 31 patients). All patients had tumors eligible for radiosurgical treatment. Primary end point was survival, secondary end points were tumor response and local control rates, overall intracranial recurrence rates, cause of death, and quality of life measurements (QL). Survival time was analyzed with the Kaplan Meier method. Prognostic factors were obtained from the Cox model. QL was assessed using the European Organization for Research and Treatment of Cancer Quality of life Questionaire (EORTC QLQ-C30 (+3) and the Brain Cancer Module 20 (BCM20).

Results: There was no significant difference between the 2 groups in overall length of survival (9.5 months surgery group, 10.3 months radiosurgery group; p=0.8) and local tumor control (82% surgery group, 97% radiosurgery group; p=0.06). Patients in the radiosurgery group experience more often distant recurrences (p=0.04) which could be effectively controlled with additional radiosurgical treatments. By multivariate analysis survival was similar for RPA class 1 and 2 patients (p=0.12). Unfavorable predictor of survival was a diagnosis of lung cancer (p=0.045). The median neurological death rates were 29% (surgery group) and 16% (radiosurgery group) (p=0.8). Radiosurgery was associated with an improved quality of life 6 weeks after treatment. Overall morbidity were 21.2% (7 patients) in the resection group, and 19.3% (6 patients) in the radiosurgery group, respectively (p>0.1).

Conclusions: In selected patients with cancer and single metastases to the brain radiosurgery should be considered as primary treatment option because it is as effective as surgery and radiotherapy and offers a good quality of life.