Single brain metastasis: Resection followed by whole-brain irradiation and a boost to the metastatic site compared to whole-brain irradiation plus radiosurgery

Objective: The most appropriate treatment for a single brain metastasis is still controversial. This matched-pair analysis compared whole-brain irradiation plus radiosurgery (WBI + RS) to neurosurgical resection followed by whole-brain irradiation and a boost to the metastatic site (NR + WBI + B). Methods: The data of 46 patients treated with WBI + RS were matched 1:1 to 46 patients treated with NR + WBI + B with respect to age, gender, Karnofsky performance score (KPS), tumor type, extracerebral metastases, and interval from first diagnosis of cancer to treatment of the metastasis, RPA class, and GPA score. Both groups were compared for local control of the treated metastasis, intracerebral control, and survival. Results: The 1-year local control rates were 85% after WBI + RS and 78% after NR + WBI + B (p = 0.35). The 1-year intracerebral control rates were 74% and 68% (p = 0.33), respectively. The 1-year survival rates were 64% and 58% (p = 0.70), respectively. A multivariate analysis was not performed for local and intracerebral control, because no factor achieved significance on univariate analyses for these endpoints. Improved survival was associated with KPS > 70 (p = 0.032), absence of extracerebral metastases (p = 0.003), RPA-class 1 (p = 0.014), and GPA score of 3.0-4.0 (p = 0.010). Conclusion: Treatment outcomes were not significantly different after WBI + RS or NR + WBI + B. Because WBI + RS is less invasive, it may be preferable for many patients with a single brain metastasis.