Among patients with 1 to 3 brain metastases, use of stereotactic radiosurgery (SRS) may result in less cognitive deterioration at 3 months, in contrast to SRS with whole brain radiotherapy (WBRT), according to a study published in JAMA.1
Researchers observed 213 patients with 1 to 3 brain metastases across 34 institutions in North America, each of whom was randomized to receive SRS or SRS plus WBRT from February 2002 to December 2013.
The study’s primary endpoint was cognitive deterioration among participants who completed the baseline and 3-month assessments. Secondary endpoints included time to intracranial failure, quality of life, functional independence, long-term cognitive status, and overall survival.
The researchers found that 63.5% of patients who underwent SRS alone experienced cognitive deterioration at 3 months, in contrast to 91.7% who underwent combined treatment with WBRT.
Quality of life was judged to be higher at 3 months with SRS alone, and time to intracranial failure was found to be significantly shorter with SRS alone than with SRS plus WBRT.
No significant difference was found in functional independence at 3 months between the 2 groups; median overall survival was 10.4 months with SRS alone, compared to 7.4 months in the SRS plus WBRT group. For long-term survivors, incidence of cognitive deterioration was less common after SRS alone at 3 months.
“In the absence of a difference in overall survival, these findings suggest that for patients with 1 to 3 brain metastases amenable to radiosurgery, SRS alone may be a preferred strategy,” the authors concluded.
- Brown PD, Jaeckle K, Ballman KV, et al. Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial. JAMA. 26 Jul 2016. doi:10.1001/jama.2016.9839 [Epub ahead of print]