Table 1.
Summary of tumor control outcomes and need for salvage in four randomized controlled studies of SRS alone vs WBRT plus SRS
| Study First Author | Patients | Randomization | 1-Year Local Recurrence | 1-Year Distant Recurrence | Rate of Salvage Therapy | Rate of Salvage WBRT | Median Survival (M) |
|---|---|---|---|---|---|---|---|
| Aoyama4 | 132 patients with | SRS | 28% | 64% | 43% | 16% | 8.0 |
| 1–4 metastases, | 11% (P = 0.002) | 41% (P = 0.003) | 16% (P < 0.001) | 0% | 7.5 (P = 0.42) | ||
| all ≤3 cm | |||||||
| - 48% with 1 met. | WBRT+SRS | ||||||
| Chang5 | 58 patients with | SRS | 23% | 55% | 87% | 33% | 15.2 |
| 1–3 brain metastases | 0% (P = 0.01) | 27% (P = 0.02) | 7% | 0% | 5.7 (P = 0.003) | ||
| - 57% with 1 met. | WBRT+SRS | ||||||
| Kocher6 | 359 patients with | SRS or resection | ~31% | ~48% | } 51% | } 31% | } 10.9 |
| ~57% | ~42% | ||||||
| 1–3 brain metastases | WBRT + SRS or WBRT + resection | ~19% | ~33% | } 16% | } 3% | } 10.7 (NS) | |
| ~27% (P < 0.003)* | ~23% (P < 0.001)* | ||||||
| - 81% with 1 met. | |||||||
| Brown7 | 213 patients with | SRS | 23% | 30% | 32% | 16% | 10.4 |
| 1–3 metastases, | 10% (P = 0.003) | 8% (P < 0.001) | 8% (P < 0.001) | 1% | 7.4 (P = 0.92) | ||
| all ≤3 cm, | WBRT+SRS | ||||||
| non-brainstem | |||||||
| - 52% with 1 met. | |||||||
| Hong8 | 207 patients with | SRS or resection | 34% | 51% | NR | NR | 13.0 |
| 1–3 metastases, | WBRT + SRS | 20% (P = 0.03) | 42% (P = 0..22) | 16.5 (P = 0.86) | |||
| all melanoma | |||||||
| - 60% with 1 met. |
*P-values comparing the addition vs omission of WBRT. NR = not reported; NS = not significant.