Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study

This European Organisation for Research and Treatment of Cancer phase III trial assesses whether adjuvant whole-brain radiotherapy (WBRT) increases the duration of functional independence after surgery or radiosurgery of brain metastases. Patients with one to three brain metastases of solid tumors (...

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Veröffentlicht in:	Journal of clinical oncology Jg. 29; H. 2; S. 134
Hauptverfasser:	Kocher, Martin, Soffietti, Riccardo, Abacioglu, Ufuk, Villà, Salvador, Fauchon, Francois, Baumert, Brigitta G, Fariselli, Laura, Tzuk-Shina, Tzahala, Kortmann, Rolf-Dieter, Carrie, Christian, Ben Hassel, Mohamed, Kouri, Mauri, Valeinis, Egils, van den Berge, Dirk, Collette, Sandra, Collette, Laurence, Mueller, Rolf-Peter
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	United States 10.01.2011
Schlagworte:	Adult Aged Aged, 80 and over Brain Neoplasms - radiotherapy Brain Neoplasms - secondary Brain Neoplasms - surgery Brain Neoplasms - therapy Disease Progression Disease-Free Survival Female Humans Male Middle Aged Radiosurgery - adverse effects Radiotherapy - adverse effects Radiotherapy, Adjuvant Salvage Therapy Survival Rate
ISSN:	1527-7755, 1527-7755
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Abstract	This European Organisation for Research and Treatment of Cancer phase III trial assesses whether adjuvant whole-brain radiotherapy (WBRT) increases the duration of functional independence after surgery or radiosurgery of brain metastases. Patients with one to three brain metastases of solid tumors (small-cell lung cancer excluded) with stable systemic disease or asymptomatic primary tumors and WHO performance status (PS) of 0 to 2 were treated with complete surgery or radiosurgery and randomly assigned to adjuvant WBRT (30 Gy in 10 fractions) or observation (OBS). The primary end point was time to WHO PS deterioration to more than 2. Of 359 patients, 199 underwent radiosurgery, and 160 underwent surgery. In the radiosurgery group, 100 patients were allocated to OBS, and 99 were allocated to WBRT. After surgery, 79 patients were allocated to OBS, and 81 were allocated to adjuvant WBRT. The median time to WHO PS more than 2 was 10.0 months (95% CI, 8.1 to 11.7 months) after OBS and 9.5 months (95% CI, 7.8 to 11.9 months) after WBRT (P = .71). Overall survival was similar in the WBRT and OBS arms (median, 10.9 v 10.7 months, respectively; P = .89). WBRT reduced the 2-year relapse rate both at initial sites (surgery: 59% to 27%, P < .001; radiosurgery: 31% to 19%, P = .040) and at new sites (surgery: 42% to 23%, P = .008; radiosurgery: 48% to 33%, P = .023). Salvage therapies were used more frequently after OBS than after WBRT. Intracranial progression caused death in 78 (44%) of 179 patients in the OBS arm and in 50 (28%) of 180 patients in the WBRT arm. After radiosurgery or surgery of a limited number of brain metastases, adjuvant WBRT reduces intracranial relapses and neurologic deaths but fails to improve the duration of functional independence and overall survival.
AbstractList	This European Organisation for Research and Treatment of Cancer phase III trial assesses whether adjuvant whole-brain radiotherapy (WBRT) increases the duration of functional independence after surgery or radiosurgery of brain metastases. Patients with one to three brain metastases of solid tumors (small-cell lung cancer excluded) with stable systemic disease or asymptomatic primary tumors and WHO performance status (PS) of 0 to 2 were treated with complete surgery or radiosurgery and randomly assigned to adjuvant WBRT (30 Gy in 10 fractions) or observation (OBS). The primary end point was time to WHO PS deterioration to more than 2. Of 359 patients, 199 underwent radiosurgery, and 160 underwent surgery. In the radiosurgery group, 100 patients were allocated to OBS, and 99 were allocated to WBRT. After surgery, 79 patients were allocated to OBS, and 81 were allocated to adjuvant WBRT. The median time to WHO PS more than 2 was 10.0 months (95% CI, 8.1 to 11.7 months) after OBS and 9.5 months (95% CI, 7.8 to 11.9 months) after WBRT (P = .71). Overall survival was similar in the WBRT and OBS arms (median, 10.9 v 10.7 months, respectively; P = .89). WBRT reduced the 2-year relapse rate both at initial sites (surgery: 59% to 27%, P < .001; radiosurgery: 31% to 19%, P = .040) and at new sites (surgery: 42% to 23%, P = .008; radiosurgery: 48% to 33%, P = .023). Salvage therapies were used more frequently after OBS than after WBRT. Intracranial progression caused death in 78 (44%) of 179 patients in the OBS arm and in 50 (28%) of 180 patients in the WBRT arm. After radiosurgery or surgery of a limited number of brain metastases, adjuvant WBRT reduces intracranial relapses and neurologic deaths but fails to improve the duration of functional independence and overall survival. This European Organisation for Research and Treatment of Cancer phase III trial assesses whether adjuvant whole-brain radiotherapy (WBRT) increases the duration of functional independence after surgery or radiosurgery of brain metastases.PURPOSEThis European Organisation for Research and Treatment of Cancer phase III trial assesses whether adjuvant whole-brain radiotherapy (WBRT) increases the duration of functional independence after surgery or radiosurgery of brain metastases.Patients with one to three brain metastases of solid tumors (small-cell lung cancer excluded) with stable systemic disease or asymptomatic primary tumors and WHO performance status (PS) of 0 to 2 were treated with complete surgery or radiosurgery and randomly assigned to adjuvant WBRT (30 Gy in 10 fractions) or observation (OBS). The primary end point was time to WHO PS deterioration to more than 2.PATIENTS AND METHODSPatients with one to three brain metastases of solid tumors (small-cell lung cancer excluded) with stable systemic disease or asymptomatic primary tumors and WHO performance status (PS) of 0 to 2 were treated with complete surgery or radiosurgery and randomly assigned to adjuvant WBRT (30 Gy in 10 fractions) or observation (OBS). The primary end point was time to WHO PS deterioration to more than 2.Of 359 patients, 199 underwent radiosurgery, and 160 underwent surgery. In the radiosurgery group, 100 patients were allocated to OBS, and 99 were allocated to WBRT. After surgery, 79 patients were allocated to OBS, and 81 were allocated to adjuvant WBRT. The median time to WHO PS more than 2 was 10.0 months (95% CI, 8.1 to 11.7 months) after OBS and 9.5 months (95% CI, 7.8 to 11.9 months) after WBRT (P = .71). Overall survival was similar in the WBRT and OBS arms (median, 10.9 v 10.7 months, respectively; P = .89). WBRT reduced the 2-year relapse rate both at initial sites (surgery: 59% to 27%, P < .001; radiosurgery: 31% to 19%, P = .040) and at new sites (surgery: 42% to 23%, P = .008; radiosurgery: 48% to 33%, P = .023). Salvage therapies were used more frequently after OBS than after WBRT. Intracranial progression caused death in 78 (44%) of 179 patients in the OBS arm and in 50 (28%) of 180 patients in the WBRT arm.RESULTSOf 359 patients, 199 underwent radiosurgery, and 160 underwent surgery. In the radiosurgery group, 100 patients were allocated to OBS, and 99 were allocated to WBRT. After surgery, 79 patients were allocated to OBS, and 81 were allocated to adjuvant WBRT. The median time to WHO PS more than 2 was 10.0 months (95% CI, 8.1 to 11.7 months) after OBS and 9.5 months (95% CI, 7.8 to 11.9 months) after WBRT (P = .71). Overall survival was similar in the WBRT and OBS arms (median, 10.9 v 10.7 months, respectively; P = .89). WBRT reduced the 2-year relapse rate both at initial sites (surgery: 59% to 27%, P < .001; radiosurgery: 31% to 19%, P = .040) and at new sites (surgery: 42% to 23%, P = .008; radiosurgery: 48% to 33%, P = .023). Salvage therapies were used more frequently after OBS than after WBRT. Intracranial progression caused death in 78 (44%) of 179 patients in the OBS arm and in 50 (28%) of 180 patients in the WBRT arm.After radiosurgery or surgery of a limited number of brain metastases, adjuvant WBRT reduces intracranial relapses and neurologic deaths but fails to improve the duration of functional independence and overall survival.CONCLUSIONAfter radiosurgery or surgery of a limited number of brain metastases, adjuvant WBRT reduces intracranial relapses and neurologic deaths but fails to improve the duration of functional independence and overall survival.
Author	Kocher, Martin Tzuk-Shina, Tzahala Mueller, Rolf-Peter Ben Hassel, Mohamed Kortmann, Rolf-Dieter Carrie, Christian Kouri, Mauri Fauchon, Francois Collette, Laurence Abacioglu, Ufuk Fariselli, Laura Soffietti, Riccardo Villà, Salvador Valeinis, Egils Collette, Sandra Baumert, Brigitta G van den Berge, Dirk
Author_xml	– sequence: 1 givenname: Martin surname: Kocher fullname: Kocher, Martin email: martin.kocher@uk-koeln.de organization: University of Cologne, Cologne, Germany. martin.kocher@uk-koeln.de – sequence: 2 givenname: Riccardo surname: Soffietti fullname: Soffietti, Riccardo – sequence: 3 givenname: Ufuk surname: Abacioglu fullname: Abacioglu, Ufuk – sequence: 4 givenname: Salvador surname: Villà fullname: Villà, Salvador – sequence: 5 givenname: Francois surname: Fauchon fullname: Fauchon, Francois – sequence: 6 givenname: Brigitta G surname: Baumert fullname: Baumert, Brigitta G – sequence: 7 givenname: Laura surname: Fariselli fullname: Fariselli, Laura – sequence: 8 givenname: Tzahala surname: Tzuk-Shina fullname: Tzuk-Shina, Tzahala – sequence: 9 givenname: Rolf-Dieter surname: Kortmann fullname: Kortmann, Rolf-Dieter – sequence: 10 givenname: Christian surname: Carrie fullname: Carrie, Christian – sequence: 11 givenname: Mohamed surname: Ben Hassel fullname: Ben Hassel, Mohamed – sequence: 12 givenname: Mauri surname: Kouri fullname: Kouri, Mauri – sequence: 13 givenname: Egils surname: Valeinis fullname: Valeinis, Egils – sequence: 14 givenname: Dirk surname: van den Berge fullname: van den Berge, Dirk – sequence: 15 givenname: Sandra surname: Collette fullname: Collette, Sandra – sequence: 16 givenname: Laurence surname: Collette fullname: Collette, Laurence – sequence: 17 givenname: Rolf-Peter surname: Mueller fullname: Mueller, Rolf-Peter
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/21041710$$D View this record in MEDLINE/PubMed
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Snippet	This European Organisation for Research and Treatment of Cancer phase III trial assesses whether adjuvant whole-brain radiotherapy (WBRT) increases the...
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SubjectTerms	Adult Aged Aged, 80 and over Brain Neoplasms - radiotherapy Brain Neoplasms - secondary Brain Neoplasms - surgery Brain Neoplasms - therapy Disease Progression Disease-Free Survival Female Humans Male Middle Aged Radiosurgery - adverse effects Radiotherapy - adverse effects Radiotherapy, Adjuvant Salvage Therapy Survival Rate
Title	Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study
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