Radiosurgery for patients with brain metastases: A multiinstitutional analysis, stratified by the RTOG recursive partitioning analysis method

Purpose: To estimate the potential improvement in survival for patients wit h brain metastases, stratified by the Radiation Therapy Oncology Group (RTO G) recursive partitioning analysis (RPA) class and treated with radiosurger y (RS) plus whole brain radiotherapy (WBRT). Methods and Materials: An analysis of the RS databases of 10 institutions i dentified patients with brain metastates treated with RS and WBRT. Patients were stratified into 1 of 3 RPA classes. Survival was evaluated using Kapl an-Meier estimates and proportional hazard regression analysis. A compariso n of survival by class was carried out with the RTOG results in similar pat ients receiving WBRT alone. Results: Five hundred two patients were eligible (261 men and 241 women, me dian age 59 years, range 26-83). The overall median survival was 10.7 month s. A higher Karnofsky performance status (p = 0.0001), a controlled primary (median survival = 11.6 vs. 8.8 months, p = 0.0023), absence of extracrani al metastases (median survival 13.4 vs. 9.1 months, p = 0.0001), and lower RPA class (median survival 16.1 months for class I vs. 10.3 months for clas s II vs. 8.7 months for class III, p = 0.000007) predicted for improved sur vival. Gender, age, primary site, radiosurgery technique, and institution w ere not prognostic. The addition of RS boosted results in median survival ( 16.1, 10.3, and 8.7 months for classes I, II, and III, respectively) compar ed with the median survival (7.1, 4.2, and 2.3 months, p < 0.05) observed i n the RTOG RPA analysis for patients treated with WBRT alone. Conclusion: In the absence of randomized data, these results suggest that R S may improve survival in patients with BM. The improvement in survival doe s not appear to be restricted by class for well-selected patients. (C) 2001 Elsevier Science Inc.