Randomized Treatment of Brain Metastasis with Gamma Knife Radiosurgery, Whole Brain Radiotherapy or Both

Joel W. Goldwein, MD
OncoLink co-Editor-In-Chief
Last Modified: October 23, 2000

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Presenter: P. B. Chougule
Affiliation Rhode Island Hospital/Brown University, Providence, RI


Summary:

Brain metastases develop in approximately 25% of all cancer patients. Management with whole brain RT may palliated these patients, but survival remains dismal. This report is of a group of patients randomized to either whole brain RT (WBRT), Gamma Knife Therapy (GK) or both (WBRT+GK).


Methods:

  • Patients were randomized to WBRT, GK or WBRT+GK, stratified by treatment site

  • Outcomes were compared for survival and local control


Results:

  • Patients were evenly distributed to the 3 arms; 34 for WBRT, 35 for GK+WBRT and 36 for GK

  • Median survival was between 5 - 7 months, and was not different for any group

  • Local control was 52% for the WBRT group, 82% for the WBRT+GK group, and 79% for the GK group (p = .0003)

  • The risk of developing a new brain lesion in un-irradiated brain was significantly higher (approx 40%) in patients who received GK therapy vs approx 20% in patients treated with WBRT or WBRT + GK

  • Surgically resected patients had a better outcome, seen primarily in patients who did not receive GK


Author's Conclusions:

  • GK therapy does not impact on survival

  • GK therapy results in improved local control

  • The risk of developing new brain lesions in patients who do not receive WBRT is higher than those who do

  • GK therapy in conjunction with whole brain RT may improve local control for some patients with brain matastases but probably does not impact survival.


Clinical/Scientific Implications:

  • Selection of patients who underwent surgical resection may have had an impact on the outcome of this study