Aoyama H et al. (2006) Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases. JAMA 295: 2483–2491

Researchers from Japan have reported that treatment with whole-brain radiotherapy (WBRT) plus stereotactic radiosurgery (SRS) confers an increase in brain tumor control without evidence of survival advantage in patients with brain metastases, when compared with SRS alone. This is the first prospective, randomized, multi-institutional study to compare the two treatment regimens.

Patients with 1–4 brain metastases, each 3 cm or less in diameter, were randomized to WBRT plus SRS (n = 65) or SRS alone (n = 67). The dose of WBRT was 30 Gy given in 10 fractions over a 2–2.5-week period. For metastatic lesions ≤2 cm and >2 cm in diameter, the SRS doses were 22–25 Gy and 18–20 Gy, respectively. In patients undergoing combined therapy, the SRS dose was reduced by 30%.

The median survival time did not differ significantly between the two treatment groups (WBRT plus SRS 7.5 months; SRS alone 8.0 months). The brain tumor recurrence rate was, however, significantly higher in patients who received SRS alone (P <0.001), and more patients in the SRS group developed new brain metastases than those in the combined therapy group (P = 0.003). Multivariate analyses revealed a significantly reduced risk of tumor recurrence (P <0.001) in patients who underwent WBRT plus SRS.

The authors conclude that the use of WBRT plus SRS does not improve survival, but that using SRS alone for the treatment of brain metastases results in a high relapse rate, necessitating frequent assessment to monitor brain tumor recurrence.