Stereotactic radiosurgery alone versus resection plus whole-brain radiotherapy for 1 or 2 brain metastases in recursive partitioning analysis class 1 and 2 patients

BACKGROUND. The objective of this study was to compare stereotactic radiosurgery (SRS) alone with resection plus whole-brain radiotherapy (WBRT) for the treatment of patients in recursive partitioning analysis (RPA) class 1 and 2 who had I or 2 brain metastases. METHODS. Two hundred six patients in RPA class 1 and 2 who had 1 or 2 brain metastases were analyzed retrospectively. Patients in Group A (n = 94) received from 18 grays (Gy) to 25 Gy SRS, and patients in Group B (n = 112) underwent resection of their metastases and received 10 X 3 Gy/20 X 2 Gy VVBRT. Eight other potential prognostic factors were evaluated regarding overall survival (OS), brain control (BC), and local control (LC) of treated metastases: age, sex, performance status, tumor type, number of brain metastases, extracranial metastases, RPA class, and interval from tumor diagnosis to treatment of brain metastases. RESULTS. A comparison of the 2 treatment groups did not reveal significantly different OS (P.19), BC (P =.52), or LC (P =.25). In RPA subgroup analyses, outcome also did not differ significantly for either RPA class of patients (P values from .21 to.83). On multivariate analysis, improved OS was associated with age <60 years (relative risk [RR], 1.75; P =.002), better performance status (RR, 1.67; P = .015), no extracranial metastases [RR], 2.84; P <.001), interval from tumor diagnosis to treatment > 12 months (RR, 1.70; P =.003), and RPA class 1 (RR, 1.51; P =.016). Improved BC was associated with a single metastasis (RR, 1.54; P =.034) and an interval from tumor diagnosis to treatment >12 months (RR, 1.58; P =.019), and improved LC was associated with an interval from tumor diagnosis to treatment >12 months (RR, 1.59; P =.047). CONCLUSIONS. SRS alone appeared to be as effective as resection plus w13RT in the treatment of I or 2 brain metastases for patients in RPA class 1 and 2. Patient outcomes were associated with age, Karnofsky performance status, number of brain metastases, extracranial metastases, RPA class, and interval from tumor diagnosis to treatment.