Table 1.
Literature review of studies comparing treatment modalities for brain metastases
| Treatment modalities | ||||
|---|---|---|---|---|
| Author (Year) | Enrollment | Study design | Median survival | Secondary outcomes |
| Surgery vs WBRT alone | ||||
| Patchell et al (1990) | Surgery: 25 vs WBRT: 23 | RCT | Surgery: 40 wk WBRT: 15 wk P < .01 | OS: <10% at 90 wk KPS > 70: 38 wk (surgery) vs 8 wk (WBRT) |
| Vecht et al (1993) | Surgery + WBRT: 32 vs WBRT alone: 31 | RCT | Surgery + WBRT: 10 mo, WBRT: 6 mo, P = −0.04 | Risk factor: extracranial metasteses |
| Mintz et al (1996) | Surgery + WBRT: 41 vs WBRT alone: 43 | RCT | Surgery + WBRT: 5.6 mo, WBRT: 6.3 mo, no difference | KFS > 70: 32% of days (both groups, P = 1), Risk factors: extracranial metasteses |
| Rades et al (2007) | Surgery + WBRT: 99 vs WBRT alone: 96 | Retrospective Cohort Study | Surgery + WBRT: 11.5 mo, WBRT: 6 mo, P < .01 | Risk factor: extracranial metasteses, Resection improved local control and control within entire brain |
| Surgery + WBRT vs Surgery alone | ||||
| Patchell et al (1998) | Surgery + WBRT: 49 vs Surgery alone: 46 | RCT | Surgery + WBRT: 48 wk, Surgery: 43 wk, no difference | Recurrance (P < .01) and neurological death (P < .01) less likely with radiotherapy |
| Surgery ± WBRT vs SRS ± WBRT | ||||
| Bindal et al (1996) | Surgery: 62 vs SRS: 31 | Retrospective Cohort Study | Surgery: 16.4 mo, SRS: 7.5 mo, P < .01 | Increased mortality after radiotherapy due to intracranial disease |
| Shinoura et al (2002) | Surgery + WBRT: 35 vs SRS: 28 | Retrospective Cohort Study | Mean Surgery + WBRT: 34.4 mo, SRS: 8.2 mo, P < .01 | Signifinantly longer time to recurrance (25 mo vs 7.2 mo, P = .02) for surgery vs SRS |
| Roos et al (2011) | Surgery + WBRT: 10 vs SRS: 11 + WBRT | RCT | Surgery: 2.8 mo, SRS: 6.2 mo, P = .2 (low accrual) | No differences in quality of life measures |
| Churilla et al (2018) | Surgery ± WBRT: 114 vs SRS ± WBRT: 154 | RCT | N/A | Early (0‐3 mo) local control was higher after SRS, but benefit was lost with time; median follow‐up 39.9 mo |
| Surgery + WBRT vs SRS | ||||
| Muacevic et al (1999) | Surgery + WBRT: 228 vs SRS: 56 | Retrospective cohort study | Surgery + WBRT: 68 wk, SRS: 35 wk, P = .19 | No difference in 1‐y OS, neurological survival, and tumor control rates |
| Schoggl et al (2000) | Surgery ± WBRT: 66 vs SRS: 67 | Retrospective cohort study | Surgery ± WBRT: 9 mo, SRS: 12 mo, P = .19 | No difference in OS. SRS had significantly better local control rates (P < .05) |
| O'Neill et al (2003) | Surgery ± WBRT: 74 vs SRS: 23 | Retrospective cohort study | One‐year OS—Surgery + WBRT: 62%, SRS: 56%, no difference | No difference in 1‐y OS. SRS had lower rate of local failure (0% vs 58%, P = .020) |
| Muacevic et al (2008) | Surgery + WBRT: 33 vs SRS: 31 | RCT | Surgery + WBRT: 9.5 mo, SRS: 10.3 mo, no difference | SRS patients had more distant recurrances (P = .04) |
| Surgery + SRS vs Surgery | ||||
| Mahajan et al (2017) | Surgery + SRS: 64 vs Surgery: 68 | RCT | Surgery + SRS: 17 mo vs Surgery: 18 mo, no difference | SRS after surgical resection of 1‐3 brain metastases results in significantly improved local control compared to surgery alone, local control at 1 y: Surgery + SRS: 72% vs Surgery: 43% (hazard ratio 0.46 [95% CI 0.24‐0.88]; P = .015). |
| Surgery + SRS vs SRS | ||||
| Prabhu et al (2017) | Surgery + SRS: 157 vs SRS: 66 | Retrospective cohort study | Surgery + SRS: 15.2 mo, SRS: 10 mo, P = .01 | Surgery + SRS was associated with significantly reduced local recurrance compared with SRS alone for patients with large BMs (≥4 cm3, 2 cm in diameter) |
| Lamba et al (2019) | Surgery + SRS: 19 vs SRS: 67 | Retrospective cohort study | Surgery + SRS: 50.4 mo, SRS: 26.2 mo, P = .02 | Resection, followed by cavity SRS is associated with improved survival in patients with 1 small brain metastasis and controlled or absent systemic disease |
| Surgery + WBRT vs Surgery + SRS | ||||
| Patel et al (2014) | Surgery + WBRT: 36 vs Surgery + SRS: 96 | Retrospective cohort study | One‐year OS—Surgery + WBRT: 55%, Surgery + SRS: 56%, no difference | No difference in 1‐y OS. Higher rate of leptomeningeal spread after adjuvant SRS vs WBRT (31% vs 13%, P = .045) |
| Kepka et al (2016) | Surgery + WBRT: 30 vs Surgery + SRS: 29 | RCT | Two‐year OS—Surgery + WBRT: 37%, Surgery + SRS: 10%, P = .046 | Non‐inferiority of SRS to the tumor bed was not demonstrated in this underpowered study. |
| Brown et al (2017) | Surgery + WBRT: 96 vs Surgery + SRS: 98 | RCT | Surgery + WBRT: 11.6 mo, Surgery + SRS: 12.2 mo, no difference | No difference in overall survival. Decline in cognitive function at 6 mo worse after WBRT (52% vs 85%, P < .001) |
| Kayama et al (2018) | Surgery + WBRT: 137 vs Surgery + SRS: 134 | RCT | Surgery + WBRT: 15.6 mo, Surgery + SRS: 15.6 mo, P = .027 for noninferiority | Salvage SRS is noninferior to WBRT |
| Supplemental WBRT after SRS/Surgery | ||||
| Kocher et al (2011) | Surgery only: 79 vs Surgery + WBRT: 81 vs SRS only: 100 vs SRS + WBRT: 99 | RCT | Supplemental WBRT: 10.9 min, Primary therapy only: 10.7 min, no difference | WBRT reduced 2‐y relapse at local (P < .05) and new sites (P < .03) |