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document
Secondary analysis of RTOG 9508 , a phase 3 randomized trial of whole-brain radiation therapy versus WBRT plus stereotactic radiosurgery in patients with 1-3 brain metastases ; poststratified by the graded prognostic assessment ( GPA ) . PURPOSE Radiation Therapy Oncology Group ( RTOG ) 9508 showed a survival advantage for patients with 1 but not 2 or 3 brain metastasis ( BM ) treated with whole-brain radiation therapy ( WBRT ) and stereotactic radiosurgery ( SRS ) versus WBRT alone . An improved prognostic index , the graded prognostic assessment ( GPA ) has been developed . Our hypothesis was that if the data from RTOG 9508 were poststratified by the GPA , the conclusions may vary . METHODS AND MATERIALS In this analysis , 252 of the 331 patients were evaluable by GPA . Of those , 211 had lung cancer . Breast cancer patients were excluded because the components of the breast GPA are not in the RTOG database . Multiple Cox regression was used to compare survival between treatment groups , adjusting for GPA . Treatment comparisons within subgroups were performed with the log-rank test . A free online tool ( brainmetgpa.com ) simplified GPA use . RESULTS The fundamental conclusions of the primary analysis were confirmed in that there was no survival benefit overall for patients with 1 to 3 metastases ; however , there was a benefit for the subset of patients with GPA 3.5 to 4.0 ( median survival time [ MST ] for WBRT + SRS vs WBRT alone was 21.0 versus 10.3 months , P=.05 ) regardless of the number of metastases . Among patients with GPA 3.5 to 4.0 treated with WBRT and SRS , the MST for patients with 1 versus 2 to 3 metastases was 21 and 14.1 months , respectively . CONCLUSIONS This secondary analysis of predominantly lung cancer patients , consistent with the original analysis , shows no survival advantage for the group overall when treated with WBRT and SRS ; however , in patients with high GPA ( 3.5-4 ) , there is a survival advantage regardless of whether they have 1 , 2 , or 3 BM . This benefit did not extend to patients with lower GPA . Prospective validation of this survival benefit for patients with multiple BM and high GPA when treated with WBRT and SRS is warranted .
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Intervention_Surgical
whole-brain radiation therapy
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Intervention_Surgical
WBRT plus stereotactic radiosurgery
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Intervention_Surgical
Radiation Therapy Oncology Group ( RTOG ) 9508
68321
Intervention_Surgical
whole-brain radiation therapy ( WBRT )
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Intervention_Surgical
stereotactic radiosurgery ( SRS
68323
Intervention_Surgical
WBRT alone
68324
Intervention_Surgical
RTOG 9508
68325
Intervention_Surgical
WBRT
68326
Intervention_Surgical
SRS
68327
Intervention_Surgical
WBRT
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Intervention_Surgical
SRS
68329
Intervention_Surgical
WBRT
68330
Intervention_Surgical
SRS
68331
Outcome_Mortality
survival benefit
68332
Outcome_Mortality
MST
68333
Outcome_Mortality
survival advantage
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Participant_Condition
1-3 brain metastases
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Participant_Condition
1 but not 2 or 3 brain metastasis ( BM )
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Participant_Sample-size
252 of the 331 patients
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Participant_Condition
lung cancer
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Participant_Condition
Breast cancer
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Participant_Condition
lung cancer