WBRT+SRS resulted in better IC and LC but not better OS than SRS alone. Because also IC and LC are important end-points, additional WBRT appears justified in patients with one to three brain metastases, in particular in RPA class I patients.

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BackgroundAddition of whole-brain irradiation (WBI) to radiosurgery for treatment of few cerebral metastases is controversial. This study aimed to create an instrument that estimates the probability of developing new cerebral metastases after radiosurgery to facilitate the decision regarding additional WBI.MethodsNine characteristics were investigated for associations with the development of new cerebral metastases including radiosurgery dose (dose equivalent to <20 Gy vs. 20 Gy vs. >20 Gy for tumor cell kill, prescribed to the 73-90% isodose level), age (≤60 vs. ≥61 years), gender, Eastern Cooperative Oncology Group performance score (0-1 vs. 2), primary tumor type (breast cancer vs. non-small lung cancer vs. malignant melanoma vs. others), number/size of cerebral metastases (1 lesion <15 mm vs. 1 lesion ≥15 mm vs. 2 or 3 lesions), location of the cerebral metastases (supratentorial alone vs. infratentorial ± supratentorial), extra-cerebra metastases (no vs. yes) and time between first diagnosis of the primary tumor and radiosurgery (≤15 vs. >15 months).ResultsNumber of cerebral metastases (p = 0.002), primary tumor type (p = 0.10) and extra-cerebral metastases (p = 0.06) showed significant associations with development of new cerebral metastases or a trend, and were integrated into the predictive instrument. Scoring points were calculated from 6-months freedom from new cerebral metastases rates. Three groups were formed, group I (16-17 points, N = 47), group II (18-20 points, N = 120) and group III (21-22 points, N = 47). Six-month rates of freedom from new cerebral metastases were 36%, 65% and 80%, respectively (p < 0.001). Corresponding rates at 12 months were 27%, 44% and 71%, respectively.ConclusionThis new instrument enables the physician to estimate the probability of developing new cerebral metastases after radiosurgery alone. Patients of groups I and II appear good candidates for additional WBI in addition to radiosurgery, whereas patients of group III may not require WBI in addition to radiosurgery.

BACKGROUND:The current study was conducted to compare neurosurgical resection (NR) followed by whole-brain irradiation (WBI) (NR þ WBI) with WBI followed by radiosurgery (WBI þ RS) in patients with a single brain metastasis. METHODS: The outcome of 41 patients treated with WBI þ RS was retrospectively compared with 111 patients who received NR ;þ WBI with respect to local control of the treated metastasis and survival. Eleven additional potential prognostic factors were investigated, including WBI schedule, patient age, patient gender, Karnofsky performance score (KPS), primary tumor type, extracerebral metastases, recursive partitioning analysis (RPA) class, interval between the first diagnosis of cancer to the treatment of brain metastasis, metastatic site, maximum diameter of the metastasis, and graded prognostic assessment (GPA) score. RESULTS: The 1-year local control rates were 87% after WBI þ RS and 56% after NR þ WBI (P ¼ .001). Using the Cox proportional hazards model, the treatment regimen remained significant (risk ratio [RR], 2.46; 95% confidence interval [95% CI], 1.29-5.17 [P ¼ .005]). On the multivariate analysis, local control was also found to be associated with the maximum diameter of the metastasis. The 1-year survival rates were 61% after WBI þ RS and 53% after NR þ WBI (P ¼ .16). Acute and late toxicities were similar in both groups. On the multivariate analysis, KPS, extracerebral metastases, RPA class, and the GPA score were found to be independent predictors of survival. CONCLUSIONS: The use of WBI þ RS resulted in significantly better local control of the treated metastasis than NR þ WBI. Survival was not found to be significantly different in either group. Because WBI þ RS is less invasive than NR þ WBI, it appears to be preferable for many patients with a single brain metastasis. These results should be confirmed in a randomized trial.