Kayama T, et al. - Researchers evaluated the noninferiority of salvage stereotactic radiosurgery (SRS) vs whole-brain radiotherapy (WBRT) in patients with brain metastases (BMs). Based on the findings, they concluded that salvage SRS is noninferior to WBRT and has the potential to serve as a standard therapy for patients with four or fewer BMs.

Methods

• This study included patients who were 20 to 79 years old with performance status scores of 0 to 2 — and 3 if caused only by neurologic deficits — and with four or fewer surgically resected BMs with only one lesion > 3 cm in diameter.
• Within 21 days of surgery, randomization of patients to WBRT or salvage SRS arms was done.
• Overall survival was primary end point.
• They used a one-sided α of .05.

Results

• A total of 137 and 134 patients were enrolled in the WBRT and salvage SRS arms, respectively between January 2006 and May 2014.
• In both arms, the observed median overall survival was 15.6 months (hazard ratio, 1.05; 90% CI, 0.83 to 1.33; one-sided P for noninferiority=.027).
• In the WBRT arm vs the salvage SRS arm, a longer median intracranial progression-free survival was reported (10.4 months vs 4.0 months, respectively).
• Findings revealed similar proportions of patients in both arms showing no worsening of Mini-Mental Status Examination and performance status scores at 12 months; however, 16.4% of patients in the WBRT arm experienced grade 2 to 4 cognitive dysfunction after 91 days after enrollment, while only 7.7% of those in the SRS arm did (P=.048).