Thomas M Churilla1, Karla V Ballman2, Paul D Brown3, Erin L Twohy4, Kurt Jaeckle5, Elana Farace6, Jane H Cerhan7, S Keith Anderson4, Xiomara W Carrero4, Yolanda I Garces7, Fred G Barker8, Richard Deming9, Jesse G Dixon4, Stuart H Burri10, Caroline Chung11, Cynthia Ménard12, Volker W Stieber13, Bruce E Pollock7, Evanthia Galanis7, Jan C Buckner7, Anthony L Asher14. 1. Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania. 2. Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota; Weill Medical College of Cornell University, New York, New York. 3. Mayo Clinic, Rochester, Minnesota. Electronic address: Brown.Paul@mayo.edu. 4. Alliance Statistics and Data Center, Mayo Clinic, Rochester, Minnesota. 5. Mayo Clinic, Jacksonville, Florida. 6. Penn State University College of Medicine, Hershey, Pennsylvania. 7. Mayo Clinic, Rochester, Minnesota. 8. Massachusetts General Hospital, Boston, Massachusetts. 9. Mercy Medical Center, Des Moines, Iowa. 10. Levine Cancer Institute, Carolinas Healthcare System, Charlotte, North Carolina. 11. University of Texas M. D. Anderson Cancer Center, Houston, Texas. 12. Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada. 13. Novant Health Forsyth Medical Center, Winston-Salem, North Carolina. 14. Levine Cancer Institute, Carolinas Healthcare System, Charlotte, North Carolina; Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina.
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.
RCT Entities:
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 NSCLCpatients 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 NSCLCpatients 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 NSCLCpatients. 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 NSCLCpatients. This study further supports the approach of SRS alone in the majority of patients with limited brain metastases.
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