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Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial
The Lancet Oncology - Online First, 10/07/09

Chang EL et al. – Patients treated with SRS plus WBRT were at a greater risk of a significant decline in learning and memory function by 4 months compared with the group that received SRS alone. Initial treatment with a combination of SRS and close clinical monitoring is recommended as the preferred treatment strategy to better preserve learning and memory in patients with newly diagnosed brain metastases.

Methods

Patients with 1 to 3 newly diagnosed brain metastases randomly assigned using standard permutated block algorithm with random block sizes to SRS plus WBRT or SRS alone from Jan 2, 2001, to Sept 14, 2007
Patients stratified by recursive partitioning analysis class, number of brain metastases, and radioresistant histology
Randomisation sequence masked until assignation, at which point both clinicians and patients were made aware of treatment allocation
Primary endpoint was neurocognitive function: objectively measured as significant deterioration (5-point drop compared with baseline) in Hopkins Verbal Learning Test—Revised (HVLT-R) total recall at 4 months
Independent data monitoring committee monitored the trial using Bayesian statistical methods.
Analysis by intention-to-treat

Results

After 58 patients recruited , the trial was stopped by data monitoring committee according to early stopping rules on basis that there was high probability (96%) that patients randomly assigned to receive SRS plus WBRT significantly more likely to show decline in learning and memory function (mean posterior probability of decline 52%) at 4 months than patients assigned to receive SRS alone (mean posterior probability of decline 24%)
At 4 months there were 4 deaths (13%) in group that received SRS alone, and 8 deaths (29%) in group that received SRS plus WBRT
73% of patients in SRS plus WBRT group free from CNS recurrence at 1 year, compared with 27% of patients who received SRS alone
SRS plus WBRT group, 1 case of grade 3 toxicity (seizures, motor neuropathy, depressed level of consciousness) attributed to radiation treatment
In the group that received SRS, 1 case of grade 3 toxicity (aphasia) attributed to radiation treatment
2 cases of grade 4 toxicity in group that received SRS alone diagnosed as radiation necrosis

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A Prospective, Phase II Study Demonstrating the Potential Value and Limitation of Radiosurgery for Spine Metastases
American Journal of Clinical Oncology, 10/06/09 Relevance Score: 88%

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Stereotactic Radiosurgery for the Treatment of Lung Neoplasm: Experience in 100 Consecutive Patients
Annals of Thoracic Surgery, 10/23/09 Relevance Score: 87%