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Significant Reduction in Local Recurrence With Conventional Surgery Over Stereotactic Radiosurgery for Single-Brain Metastases: Presented at AANS

By Mary Beth Nierengarten

CHICAGO -- May 5, 2008 -- New data from the first randomised comparison of conventional surgery versus stereotactic radiosurgery for patients with single-brain metastases suggest an advantage with conventional surgery based on a significantly reduced rate of local recurrence, investigators reported here at the 76th Annual Meeting of the American Association of Neurological Surgeons (AANS).

These results suggest that "conventional surgery should be considered the gold standard for treatment of patients with single-brain metastases when either treatment is feasible," according to lead author Frederick F. Lang, MD, FACS, Professor and Director of Clinical Research, Department of Neurosurgery, University of Texas M. D. Anderson Cancer Center, Houston, Texas.

The prospective trial included 214 patients with newly diagnosed, single-brain metastases; 119 were treated by conventional surgery (CS) and 95 by stereotactic radiosurgery (SRS).

Of the full cohort, 59 patients agreed to be randomised to CS (n = 30) or SRS (n = 29), while 155 patients refused randomisation and chose their own treatment (89 chose CS and 66 chose SRS).

Patients were included in the study if they were at least 16 years old and had a Karnofsky performance scale (KPS) score of 70 or more. Patient characteristics were similar between the randomised and nonrandomised groups.

Based a pooled analysis of both randomised and nonrandomised groups adjusted for confounding variables (age, gender, whole-brain radiotherapy, primary tumour type, extent of disease, tumour volume and location, and KPS score), multivariate analysis showed a significant increase in the risk of local recurrence in patients treated with CS compared with SRS (hazard ratio [HR], 2.7; 95% confidence interval [CI], 1.3-5.5; P = .006). No difference in distant disease was found between the 2 treatments (HR, 1.1; 95% CI, 0.7-1.7; P = .73).

The study also looked at results of each arm separately, accounting for patients who crossed over into the nonrandomised arm from the randomised arm. The crossover analysis included 55 randomised patients and 138 nonrandomised patients. Results showed that local recurrence was significantly higher in the SRS-treated patients compared with CS for the randomised patients (35% vs 18%), nonrandomised patients (31% vs 14%), and combined patient cohorts (32% vs 15%, P < .01 for each).

The authors concluded that CS provides a significant advantage in reducing local recurrence over SRS in patients with newly diagnosed, single-brain metastases.


[Presentation title: Conventional Surgery Versus Stereotactic Radiosurgery in the Treatment of Single Brain Metastases: A Prospective Study With Both Randomized and Nonrandomized Arms. Abstract 601]

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