Table 1.
Summary of selected trials evaluating the role of SRS ± WBRT for patients with limited brain metastases.
| Trial | Patient selection | Primary endpoint | Local control | OS | Functional outcome |
|---|---|---|---|---|---|
| Aoyama et al. (46) SRS N = 67 WBRT + SRS N = 65 |
1–4 metastases, KPS ≥ 70, lesion diameter <3 cm | Cranial recurrence | 1 year: 72.5 vs 88.7% (p = 0.002) | 1 year: 28.4 vs 38.5% (p = 0.42) | No difference in cognition based on MMSE |
| Aoyama et al. (24) SRS N = 45 WBRT + SRS N = 43 |
1–4 metastases, NSCLC patients | OS according DS-GPA score | – | DS-GPA favorable: 10.6 vs 16.7 months (p = 0.04) DS-GPA unfavorable: 6.5 vs 4.75 months |
No difference in neurocognitive function based on MMSE |
| Chang et al. (47) SRS N = 30 WBRT + SRS N = 28 |
1–3 metastases, KPS ≥ 70 | Neurocognition (using HVLT-R) | 1 year: 67 vs 100% (p = 0.012) | 15.2 vs 5.7 months | HVLT-R decline 52 vs 24% |
| Kocher et al. (44) SRS N = 100 WBRT + SRS N = 99 |
1–3 metastases, WHO ≤ 2 | Functional independence (WHO ≥ 2) | 2 year: 69 vs 81% (p = 0.04) | 10.9 vs 10.7 months (p = 0.89) | No difference 10.0 vs 9.5 months |
| Brown et al. (51) SRS N = 111 WBRT + SRS N = 102 |
1–3 metastases, diameter < 3 cm, ECOG performance score ≤2 | Cognitive deterioration | 3 months: 75.3 vs 93.7% (p< 0.001) | 10.4 vs 7.4 months (p = 0.92) | Higher deterioration in verbal fluency and delayed/immediate memory in SRS + WBRT arm |
| Churilla et al. (53) SRS WBRT + SRS |
1–3 metastases, NSCLC patients | OS according DS-GPA score | – | 10.8 vs 7.5 months | No difference in survival in favorable-prognosis NSCLC patient |
KPS, Karnofsky performance status; WBRT, whole-brain radiotherapy; SRS, stereotactic radiosurgery; WHO, World Health Organization; HVLT-R, Hopkins Verbal Learning Test revised; OS, overall survival. NSCLC, non-small cell lung cancer. MMSE, Mini-Mental State Examination; DS-GPA; diagnosis-specific Graded Prognostic Assessment.