From the Guidelines
The key findings of Patchell's study on solitary brain metastases are that surgical resection followed by whole-brain radiation therapy (WBRT) significantly improves survival compared to WBRT alone, with a median survival increase from 40 weeks to 45 weeks 1.
Key Study Details
- The study involved 84 patients randomized to either WBRT alone or resection followed by WBRT, with a radiotherapy dose of 39 Gy in 13 fractions.
- A subsequent trial by Patchell and colleagues 1 found that the addition of WBRT to resection increased control of cancer within the brain, but had no effect on overall survival.
- The radiotherapy dose in the second trial was 50.4 Gy in 28 fractions, and the study involved 95 patients with solitary resected brain metastasis randomized to either WBRT or observation.
Implications of the Study
- The findings of Patchell's study suggest that WBRT may not be necessary for all patients with solitary brain metastases, particularly those with a good prognosis, due to the potential side effects of WBRT in long-term survivors.
- However, omitting WBRT after focal therapy, such as resection or stereotactic radiosurgery (SRS), may lead to decreased control of intracranial metastases and is not associated with a survival advantage 1.
From the Research
Key Findings of Patchell's Study
- The study compared surgical resection in combination with whole-brain radiation therapy (WBRT) versus hypofractionated stereotactic irradiation (HCSRT) in the treatment of solitary brain metastases 2.
- The results showed that patients treated with resection + WBRT had a significantly longer survival time (median 7.9, mean 12.9 months) compared to HCSRT (median 5.0, mean 7.6 months) 2.
- Local recurrence was observed in 28% of patients treated with resection + WBRT after a median time of 8.0 months, whereas 16% of patients in the HCSRT group experienced local recurrence after a median time of 3.0 months 2.
- The study suggests that surgical resection in combination with WBRT may be an option even for small brain metastases suitable for treatment with HCSRT, considering factors such as tumor location and expected neurological outcome 2.
Comparison with Other Studies
- A 2018 study comparing surgery versus stereotactic radiotherapy for people with single or solitary brain metastasis found no difference in overall survival between the two treatments, but the certainty of evidence was low or very low due to high risk of bias and imprecision 3.
- A 1999 study comparing surgery plus WBRT with gamma knife radiosurgery alone for solitary cerebral metastases of small diameter found no significant difference in 1-year survival rates (53% vs 43%) or local tumor control rates (75% vs 83%) between the two groups 4.
- A 2006 study on nonsmall cell lung cancer presenting with synchronous solitary brain metastasis suggested that aggressive treatment of the primary site may be justified for newly diagnosed thoracic Stage I NSCLC patients with a solitary brain metastasis, but not for locally advanced NSCLC patients with a solitary brain metastasis 5.