NEW YORK (Reuters Health) – When added to whole-brain irradiation, radiosurgery is preferable to neurosurgical resection for treating cancer patients with a single metastasis to the brain, according to the findings of a retrospective German study.

“These results should be confirmed in a randomized trial,” the researchers suggest in their report in the July 14 online issue of Cancer.

Dr. Dirk Rades, with University Hospital Schleswig-Holstein in Lubeck, and colleagues explain that neurosurgical resection followed by whole-brain irradiation (WBI) has become the standard treatment for patients with a single brain metastasis, but there’s evidence that outcomes might be better with radiosurgery, with or without WBI.

However, they say, it’s difficult to interpret available studies of various combinations of WBI, radiosurgery and neurosurgery.

In the current study, the team compared outcomes in patients with a single brain metastasis who underwent either neurosurgical resection followed by WBI (n=111), or WBI first followed by radiosurgery (n=41).

The primary tumor was breast cancer in 34 of the patients, lung cancer in 11355, and other sites in 46. The brain metastasis was no larger than 4 cm in all cases.

Local control was defined as no progression or recurrence of the brain metastasis as seen on MRI, the investigators explain. “To allow for better differentiation between local failure and radiation-induced necrosis in the WBI plus radiosurgery group, the MRI scans were reviewed by specialized neuroradiologists.”

Local control rates at 1 year were 87% after WBI plus radiosurgery and 56% after neurosurgical resection plus WBI (p =0.001), the team found. However, 1-year survival rates were not significantly different in the two groups at 61% and 53% respectively (p=0.16).

Acute toxicity of grade 2 or higher, such as nausea or fatigue, occurred in 15% of patients in both groups, while the rate of late toxicities such as neurocognitive deficits or vision problems occurred in 5% of the radiosurgery group and 7% of the neurosurgery group.

Given the comparable survival rates, Dr. Rades and colleagues conclude, “Because WBI plus radiosurgery is less invasive and appears to result in better local control, it appears preferable to neurosurgical resection plus WBI for many patients with a single brain metastasis.”

Reference:
Single brain metastasis: Whole-brain irradiation plus either radiosurgery or neurosurgical resection
Cancer 2011.