Stereotactic Radiosurgery With or Without Whole-Brain Radiation Therapy for Limited Brain Metastases: A Secondary Analysis of the North Central Cancer Treatment Group N0574 (Alliance) Randomized Controlled Trial

Thomas M. Churilla, Karla V. Ballman, Paul D. Brown, Erin L. Twohy, Kurt Jaeckle, Elana Farace, Jane H. Cerhan, S. Keith Anderson, Xiomara W. Carrero, Yolanda I. Garces, Fred G. Barker, Richard Deming, Jesse G. Dixon, Stuart H. Burri, Caroline Chung, Cynthia Ménard, Volker W. Stieber, Bruce E. Pollock, Evanthia Galanis, Jan C. BucknerAnthony L. Asher

Research output: Contribution to journalArticle

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Abstract

Purpose To determine whether whole-brain radiation therapy (WBRT) is associated with improved overall survival among non-small cell lung cancer (NSCLC) patients with favorable prognoses at diagnosis. Methods and Materials In the N0574 trial, patients with 1 to 3 brain metastases were randomized to receive stereotactic radiosurgery (SRS) or SRS plus WBRT (SRS + WBRT), with a primary endpoint of cognitive deterioration. We calculated diagnosis-specific graded prognostic assessment (DS-GPA) scores for NSCLC patients and evaluated overall survival according to receipt of WBRT and DS-GPA score using 2 separate cut-points (≥2.0 vs <2.0 and ≥2.5 vs <2.5). Results A total of 126 NSCLC patients were included for analysis, with median follow-up of 14.2 months. Data for DS-GPA calculation were available for 86.3% of all enrolled NSCLC patients. Overall, 50.0% of patients had DS-GPA score ≥2.0, and 23.0% of patients had DS-GPA scores ≥2.5. The SRS and SRS + WBRT groups were well balanced with regard to prognostic factors. The median survival according to receipt of WBRT was 11.3 months (+WBRT) and 17.9 months (−WBRT) for patients with DS-GPA ≥2.0 (favorable prognoses, P=.63; hazard ratio 0.86; 95% confidence interval 0.47-1.59). Median survival was 3.7 months (+WBRT) and 6.6 months (−WBRT) for patients with DS-GPA <2.0 patients (unfavorable prognoses, P=.85; hazard ratio 0.95; 95% confidence interval 0.56-1.62). Outcomes according to the receipt of WBRT and DS-GPA remained similar utilizing DS-GPA ≥2.5 as a cutoff for favorable prognoses. There was no interaction between the continuum of the DS-GPA groups and WBRT on overall survival (P=.53). Conclusions We observed no significant differences in survival according to receipt of WBRT in favorable-prognosis NSCLC patients. This study further supports the approach of SRS alone in the majority of patients with limited brain metastases.

Original languageEnglish (US)
Pages (from-to)1173-1178
Number of pages6
JournalInternational Journal of Radiation Oncology Biology Physics
Volume99
Issue number5
DOIs
StatePublished - Dec 1 2017

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Radiosurgery
metastasis
brain
radiation therapy
Radiotherapy
Randomized Controlled Trials
cancer
Neoplasm Metastasis
Brain
Neoplasms
prognosis
Non-Small Cell Lung Carcinoma
lungs
Therapeutics
Survival
hazards
confidence
Confidence Intervals
intervals
deterioration

All Science Journal Classification (ASJC) codes

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

Cite this

Churilla, Thomas M. ; Ballman, Karla V. ; Brown, Paul D. ; Twohy, Erin L. ; Jaeckle, Kurt ; Farace, Elana ; Cerhan, Jane H. ; Anderson, S. Keith ; Carrero, Xiomara W. ; Garces, Yolanda I. ; Barker, Fred G. ; Deming, Richard ; Dixon, Jesse G. ; Burri, Stuart H. ; Chung, Caroline ; Ménard, Cynthia ; Stieber, Volker W. ; Pollock, Bruce E. ; Galanis, Evanthia ; Buckner, Jan C. ; Asher, Anthony L. / Stereotactic Radiosurgery With or Without Whole-Brain Radiation Therapy for Limited Brain Metastases : A Secondary Analysis of the North Central Cancer Treatment Group N0574 (Alliance) Randomized Controlled Trial. In: International Journal of Radiation Oncology Biology Physics. 2017 ; Vol. 99, No. 5. pp. 1173-1178.
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title = "Stereotactic Radiosurgery With or Without Whole-Brain Radiation Therapy for Limited Brain Metastases: A Secondary Analysis of the North Central Cancer Treatment Group N0574 (Alliance) Randomized Controlled Trial",
abstract = "Purpose To determine whether whole-brain radiation therapy (WBRT) is associated with improved overall survival among non-small cell lung cancer (NSCLC) patients with favorable prognoses at diagnosis. Methods and Materials In the N0574 trial, patients with 1 to 3 brain metastases were randomized to receive stereotactic radiosurgery (SRS) or SRS plus WBRT (SRS + WBRT), with a primary endpoint of cognitive deterioration. We calculated diagnosis-specific graded prognostic assessment (DS-GPA) scores for NSCLC patients and evaluated overall survival according to receipt of WBRT and DS-GPA score using 2 separate cut-points (≥2.0 vs <2.0 and ≥2.5 vs <2.5). Results A total of 126 NSCLC patients were included for analysis, with median follow-up of 14.2 months. Data for DS-GPA calculation were available for 86.3{\%} of all enrolled NSCLC patients. Overall, 50.0{\%} of patients had DS-GPA score ≥2.0, and 23.0{\%} of patients had DS-GPA scores ≥2.5. The SRS and SRS + WBRT groups were well balanced with regard to prognostic factors. The median survival according to receipt of WBRT was 11.3 months (+WBRT) and 17.9 months (−WBRT) for patients with DS-GPA ≥2.0 (favorable prognoses, P=.63; hazard ratio 0.86; 95{\%} confidence interval 0.47-1.59). Median survival was 3.7 months (+WBRT) and 6.6 months (−WBRT) for patients with DS-GPA <2.0 patients (unfavorable prognoses, P=.85; hazard ratio 0.95; 95{\%} confidence interval 0.56-1.62). Outcomes according to the receipt of WBRT and DS-GPA remained similar utilizing DS-GPA ≥2.5 as a cutoff for favorable prognoses. There was no interaction between the continuum of the DS-GPA groups and WBRT on overall survival (P=.53). Conclusions We observed no significant differences in survival according to receipt of WBRT in favorable-prognosis NSCLC patients. This study further supports the approach of SRS alone in the majority of patients with limited brain metastases.",
author = "Churilla, {Thomas M.} and Ballman, {Karla V.} and Brown, {Paul D.} and Twohy, {Erin L.} and Kurt Jaeckle and Elana Farace and Cerhan, {Jane H.} and Anderson, {S. Keith} and Carrero, {Xiomara W.} and Garces, {Yolanda I.} and Barker, {Fred G.} and Richard Deming and Dixon, {Jesse G.} and Burri, {Stuart H.} and Caroline Chung and Cynthia M{\'e}nard and Stieber, {Volker W.} and Pollock, {Bruce E.} and Evanthia Galanis and Buckner, {Jan C.} and Asher, {Anthony L.}",
year = "2017",
month = "12",
day = "1",
doi = "10.1016/j.ijrobp.2017.07.045",
language = "English (US)",
volume = "99",
pages = "1173--1178",
journal = "International Journal of Radiation Oncology Biology Physics",
issn = "0360-3016",
publisher = "Elsevier Inc.",
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}

Churilla, TM, Ballman, KV, Brown, PD, Twohy, EL, Jaeckle, K, Farace, E, Cerhan, JH, Anderson, SK, Carrero, XW, Garces, YI, Barker, FG, Deming, R, Dixon, JG, Burri, SH, Chung, C, Ménard, C, Stieber, VW, Pollock, BE, Galanis, E, Buckner, JC & Asher, AL 2017, 'Stereotactic Radiosurgery With or Without Whole-Brain Radiation Therapy for Limited Brain Metastases: A Secondary Analysis of the North Central Cancer Treatment Group N0574 (Alliance) Randomized Controlled Trial', International Journal of Radiation Oncology Biology Physics, vol. 99, no. 5, pp. 1173-1178. https://doi.org/10.1016/j.ijrobp.2017.07.045

Stereotactic Radiosurgery With or Without Whole-Brain Radiation Therapy for Limited Brain Metastases : A Secondary Analysis of the North Central Cancer Treatment Group N0574 (Alliance) Randomized Controlled Trial. / Churilla, Thomas M.; Ballman, Karla V.; Brown, Paul D.; Twohy, Erin L.; Jaeckle, Kurt; Farace, Elana; Cerhan, Jane H.; Anderson, S. Keith; Carrero, Xiomara W.; Garces, Yolanda I.; Barker, Fred G.; Deming, Richard; Dixon, Jesse G.; Burri, Stuart H.; Chung, Caroline; Ménard, Cynthia; Stieber, Volker W.; Pollock, Bruce E.; Galanis, Evanthia; Buckner, Jan C.; Asher, Anthony L.

In: International Journal of Radiation Oncology Biology Physics, Vol. 99, No. 5, 01.12.2017, p. 1173-1178.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Stereotactic Radiosurgery With or Without Whole-Brain Radiation Therapy for Limited Brain Metastases

T2 - A Secondary Analysis of the North Central Cancer Treatment Group N0574 (Alliance) Randomized Controlled Trial

AU - Churilla, Thomas M.

AU - Ballman, Karla V.

AU - Brown, Paul D.

AU - Twohy, Erin L.

AU - Jaeckle, Kurt

AU - Farace, Elana

AU - Cerhan, Jane H.

AU - Anderson, S. Keith

AU - Carrero, Xiomara W.

AU - Garces, Yolanda I.

AU - Barker, Fred G.

AU - Deming, Richard

AU - Dixon, Jesse G.

AU - Burri, Stuart H.

AU - Chung, Caroline

AU - Ménard, Cynthia

AU - Stieber, Volker W.

AU - Pollock, Bruce E.

AU - Galanis, Evanthia

AU - Buckner, Jan C.

AU - Asher, Anthony L.

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Purpose To determine whether whole-brain radiation therapy (WBRT) is associated with improved overall survival among non-small cell lung cancer (NSCLC) patients with favorable prognoses at diagnosis. Methods and Materials In the N0574 trial, patients with 1 to 3 brain metastases were randomized to receive stereotactic radiosurgery (SRS) or SRS plus WBRT (SRS + WBRT), with a primary endpoint of cognitive deterioration. We calculated diagnosis-specific graded prognostic assessment (DS-GPA) scores for NSCLC patients and evaluated overall survival according to receipt of WBRT and DS-GPA score using 2 separate cut-points (≥2.0 vs <2.0 and ≥2.5 vs <2.5). Results A total of 126 NSCLC patients were included for analysis, with median follow-up of 14.2 months. Data for DS-GPA calculation were available for 86.3% of all enrolled NSCLC patients. Overall, 50.0% of patients had DS-GPA score ≥2.0, and 23.0% of patients had DS-GPA scores ≥2.5. The SRS and SRS + WBRT groups were well balanced with regard to prognostic factors. The median survival according to receipt of WBRT was 11.3 months (+WBRT) and 17.9 months (−WBRT) for patients with DS-GPA ≥2.0 (favorable prognoses, P=.63; hazard ratio 0.86; 95% confidence interval 0.47-1.59). Median survival was 3.7 months (+WBRT) and 6.6 months (−WBRT) for patients with DS-GPA <2.0 patients (unfavorable prognoses, P=.85; hazard ratio 0.95; 95% confidence interval 0.56-1.62). Outcomes according to the receipt of WBRT and DS-GPA remained similar utilizing DS-GPA ≥2.5 as a cutoff for favorable prognoses. There was no interaction between the continuum of the DS-GPA groups and WBRT on overall survival (P=.53). Conclusions We observed no significant differences in survival according to receipt of WBRT in favorable-prognosis NSCLC patients. This study further supports the approach of SRS alone in the majority of patients with limited brain metastases.

AB - Purpose To determine whether whole-brain radiation therapy (WBRT) is associated with improved overall survival among non-small cell lung cancer (NSCLC) patients with favorable prognoses at diagnosis. Methods and Materials In the N0574 trial, patients with 1 to 3 brain metastases were randomized to receive stereotactic radiosurgery (SRS) or SRS plus WBRT (SRS + WBRT), with a primary endpoint of cognitive deterioration. We calculated diagnosis-specific graded prognostic assessment (DS-GPA) scores for NSCLC patients and evaluated overall survival according to receipt of WBRT and DS-GPA score using 2 separate cut-points (≥2.0 vs <2.0 and ≥2.5 vs <2.5). Results A total of 126 NSCLC patients were included for analysis, with median follow-up of 14.2 months. Data for DS-GPA calculation were available for 86.3% of all enrolled NSCLC patients. Overall, 50.0% of patients had DS-GPA score ≥2.0, and 23.0% of patients had DS-GPA scores ≥2.5. The SRS and SRS + WBRT groups were well balanced with regard to prognostic factors. The median survival according to receipt of WBRT was 11.3 months (+WBRT) and 17.9 months (−WBRT) for patients with DS-GPA ≥2.0 (favorable prognoses, P=.63; hazard ratio 0.86; 95% confidence interval 0.47-1.59). Median survival was 3.7 months (+WBRT) and 6.6 months (−WBRT) for patients with DS-GPA <2.0 patients (unfavorable prognoses, P=.85; hazard ratio 0.95; 95% confidence interval 0.56-1.62). Outcomes according to the receipt of WBRT and DS-GPA remained similar utilizing DS-GPA ≥2.5 as a cutoff for favorable prognoses. There was no interaction between the continuum of the DS-GPA groups and WBRT on overall survival (P=.53). Conclusions We observed no significant differences in survival according to receipt of WBRT in favorable-prognosis NSCLC patients. This study further supports the approach of SRS alone in the majority of patients with limited brain metastases.

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