Comparative effectiveness of stereotactic radiosurgery versus whole‐brain radiation therapy for patients with brain metastases from breast or non–small cell lung cancer. Issue 13 (18th April 2016)

• Record Type: Journal Article
• Authors: Halasz, Lia M.; Uno, Hajime; Hughes, Melissa; D'Amico, Thomas; Dexter, Elisabeth U.; Edge, Stephen B.; Hayman, James A.; Niland, Joyce C.; Otterson, Gregory A.; Pisters, Katherine M. W.; Theriault, Richard; Weeks, Jane C.; Punglia, Rinaa S.
• Is Part Of: Cancer. Volume 122:Issue 13(2016)
• Page Start: 2091
• Page End: 100
• Publication Date: 2016-04-18
• Subjects: breast neoplasms -- comparative effectiveness research -- neoplasm metastasis -- non–small cell lung carcinoma -- radiosurgery; Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.30009
• Languages: English
• ISSNs: 0008-543X

Abstract

Abstract : BACKGROUND: The optimal treatment for patients with brain metastases remains controversial as the use of stereotactic radiosurgery (SRS) alone, replacing whole‐brain radiation therapy (WBRT), has increased. This study determined the patterns of care at multiple institutions before 2010 and examined whether or not survival was different between patients treated with SRS and patients treated with WBRT. METHODS: This study examined the overall survival of patients treated with radiation therapy for brain metastases from non–small cell lung cancer (NSCLC; initially diagnosed in 2007‐2009) or breast cancer (initially diagnosed in 1997‐2009) at 5 centers. Propensity score analyses were performed to adjust for confounding factors such as the number of metastases, the extent of extracranial metastases, and the treatment center. RESULTS: Overall, 27.8% of 400 NSCLC patients and 13.4% of 387 breast cancer patients underwent SRS alone for the treatment of brain metastases. Few patients with more than 3 brain metastases or lesions ≥ 4 cm in size underwent SRS. Patients with fewer than 4 brain metastases less than 4 cm in size (n = 189 for NSCLC and n = 117 for breast cancer) who were treated with SRS had longer survival (adjusted hazard ratio [HR] for NSCLC, 0.58; 95% confidence Interval [CI], 0.38‐0.87; P = .01; adjusted HR for breast cancer, 0.54; 95% CI, 0.33‐0.91; P = .02) than those treated with WBRT. CONCLUSIONS: Patients treated for fewer than 4 brain metastases from NSCLC or breast cancer with SRS alone had longer survival than those treated with WBRT in this multi‐institutional, retrospective study, even after adjustments for the propensity to undergo SRS. Cancer 2016;122:2091–100 . © 2016 American Cancer Society . Abstract : With data from a multi‐institutional, longitudinal database, propensity score analyses have been performed for patients treated for brain metastases from non–small cell lung cancer or breast cancer. Patients treated initially for fewer than 4 brain metastases with stereotactic radiosurgery alone have improved survival.