Article
A randomized trial of surgery and radiotherapy versus radiosurgery alone in the treatment of single metastasis in the brain
Randomisierte Studie zum Vergleich von Chirurgie und Radiotherapie versus alleinige Radiochirurgie für die Behandlung von singulären Hirnmetastasen
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Authors
Published: | May 4, 2005 |
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Outline
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Objective
To assess whether outpatient radiosurgery alone is as effective as surgery and whole brain irradiation (WBRT) for survival and neurological control of disease in patients with single brain metastasis.
Methods
64 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 (radiosurgery group, 31 patients). All patients had tumours eligible for radiosurgical treatment. Primary end point was survival, secondary end points were tumour response and local control rates, overall intracranial recurrence rates, cause of death, and quality of life measurements. Survival time was analyzed with the Kaplan-Meier method. Prognostic factors were obtained from the Cox model.
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 tumour control (82% surgery group, 97% radiosurgery group; p=0.06). Patients in the radiosurgery group experienced more distant recurrences (p=0.04) which could be effectively controlled with additional radiosurgical treatment. Survival improved in patients with an RPA class 1. Quality of life was favourable in the radiosurgery group.
Conclusions
In selected patients with cancer and single brain metastasis radiosurgery should be considered as primary treatment option because it is as effective as surgery and radiotherapy and offers a comparably good quality of life.