Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: Results of the EORTC 22952-26001 study

Martin Kocher, Riccardo Soffietti, Ufuk Abacioglu, Salvador Villà, Francois Fauchon, Brigitta G. Baumert, Laura Fariselli, Tzahala Tzuk-Shina, Rolf Dieter Kortmann, Christian Carrie, Mohamed Ben Hassel, Mauri Kouri, Egils Valeinis, Dirk Van Den Berge, Sandra Collette, Laurence Collette, Rolf Peter Mueller

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Abstract

Purpose: This European Organisation for Research and Treatment of Cancer phase III trial assesses whether adjuvant whole-brain radiotherapy (WBRT) increases the duration of functional independence after surgery or radiosurgery of brain metastases. Patients and Methods: Patients with one to three brain metastases of solid tumors (small-cell lung cancer excluded) with stable systemic disease or asymptomatic primary tumors and WHO performance status (PS) of 0 to 2 were treated with complete surgery or radiosurgery and randomly assigned to adjuvant WBRT (30 Gy in 10 fractions) or observation (OBS). The primary end point was time to WHO PS deterioration to more than 2. Results: Of 359 patients, 199 underwent radiosurgery, and 160 underwent surgery. In the radiosurgery group, 100 patients were allocated to OBS, and 99 were allocated to WBRT. After surgery, 79 patients were allocated to OBS, and 81 were allocated to adjuvant WBRT. The median time to WHO PS more than 2 was 10.0 months (95% CI, 8.1 to 11.7 months) after OBS and 9.5 months (95% CI, 7.8 to 11.9 months) after WBRT (P = .71). Overall survival was similar in the WBRT and OBS arms (median, 10.9 v 10.7 months, respectively; P = .89). WBRT reduced the 2-year relapse rate both at initial sites (surgery: 59% to 27%, P <.001; radiosurgery: 31% to 19%, P = .040) and at new sites (surgery: 42% to 23%, P = .008; radiosurgery: 48% to 33%, P = .023). Salvage therapies were used more frequently after OBS than after WBRT. Intracranial progression caused death in 78 (44%) of 179 patients in the OBS arm and in 50 (28%) of 180 patients in the WBRT arm. Conclusion: After radiosurgery or surgery of a limited number of brain metastases, adjuvant WBRT reduces intracranial relapses and neurologic deaths but fails to improve the duration of functional independence and overall survival.

Original languageEnglish
Pages (from-to)134-141
Number of pages8
JournalJournal of Clinical Oncology
Volume29
Issue number2
DOIs
Publication statusPublished - Jan 10 2011

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Radiosurgery
Radiotherapy
Observation
Neoplasm Metastasis
Brain
Asymptomatic Diseases
Recurrence
Salvage Therapy
Survival
Small Cell Lung Carcinoma
Nervous System
Neoplasms

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

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Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases : Results of the EORTC 22952-26001 study. / Kocher, Martin; Soffietti, Riccardo; Abacioglu, Ufuk; Villà, Salvador; Fauchon, Francois; Baumert, Brigitta G.; Fariselli, Laura; Tzuk-Shina, Tzahala; Kortmann, Rolf Dieter; Carrie, Christian; Ben Hassel, Mohamed; Kouri, Mauri; Valeinis, Egils; Van Den Berge, Dirk; Collette, Sandra; Collette, Laurence; Mueller, Rolf Peter.

In: Journal of Clinical Oncology, Vol. 29, No. 2, 10.01.2011, p. 134-141.

Research output: Contribution to journalArticle

Kocher, M, Soffietti, R, Abacioglu, U, Villà, S, Fauchon, F, Baumert, BG, Fariselli, L, Tzuk-Shina, T, Kortmann, RD, Carrie, C, Ben Hassel, M, Kouri, M, Valeinis, E, Van Den Berge, D, Collette, S, Collette, L & Mueller, RP 2011, 'Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: Results of the EORTC 22952-26001 study', Journal of Clinical Oncology, vol. 29, no. 2, pp. 134-141. https://doi.org/10.1200/JCO.2010.30.1655
Kocher, Martin ; Soffietti, Riccardo ; Abacioglu, Ufuk ; Villà, Salvador ; Fauchon, Francois ; Baumert, Brigitta G. ; Fariselli, Laura ; Tzuk-Shina, Tzahala ; Kortmann, Rolf Dieter ; Carrie, Christian ; Ben Hassel, Mohamed ; Kouri, Mauri ; Valeinis, Egils ; Van Den Berge, Dirk ; Collette, Sandra ; Collette, Laurence ; Mueller, Rolf Peter. / Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases : Results of the EORTC 22952-26001 study. In: Journal of Clinical Oncology. 2011 ; Vol. 29, No. 2. pp. 134-141.
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abstract = "Purpose: This European Organisation for Research and Treatment of Cancer phase III trial assesses whether adjuvant whole-brain radiotherapy (WBRT) increases the duration of functional independence after surgery or radiosurgery of brain metastases. Patients and Methods: Patients with one to three brain metastases of solid tumors (small-cell lung cancer excluded) with stable systemic disease or asymptomatic primary tumors and WHO performance status (PS) of 0 to 2 were treated with complete surgery or radiosurgery and randomly assigned to adjuvant WBRT (30 Gy in 10 fractions) or observation (OBS). The primary end point was time to WHO PS deterioration to more than 2. Results: Of 359 patients, 199 underwent radiosurgery, and 160 underwent surgery. In the radiosurgery group, 100 patients were allocated to OBS, and 99 were allocated to WBRT. After surgery, 79 patients were allocated to OBS, and 81 were allocated to adjuvant WBRT. The median time to WHO PS more than 2 was 10.0 months (95{\%} CI, 8.1 to 11.7 months) after OBS and 9.5 months (95{\%} CI, 7.8 to 11.9 months) after WBRT (P = .71). Overall survival was similar in the WBRT and OBS arms (median, 10.9 v 10.7 months, respectively; P = .89). WBRT reduced the 2-year relapse rate both at initial sites (surgery: 59{\%} to 27{\%}, P <.001; radiosurgery: 31{\%} to 19{\%}, P = .040) and at new sites (surgery: 42{\%} to 23{\%}, P = .008; radiosurgery: 48{\%} to 33{\%}, P = .023). Salvage therapies were used more frequently after OBS than after WBRT. Intracranial progression caused death in 78 (44{\%}) of 179 patients in the OBS arm and in 50 (28{\%}) of 180 patients in the WBRT arm. Conclusion: After radiosurgery or surgery of a limited number of brain metastases, adjuvant WBRT reduces intracranial relapses and neurologic deaths but fails to improve the duration of functional independence and overall survival.",
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T2 - Results of the EORTC 22952-26001 study

AU - Kocher, Martin

AU - Soffietti, Riccardo

AU - Abacioglu, Ufuk

AU - Villà, Salvador

AU - Fauchon, Francois

AU - Baumert, Brigitta G.

AU - Fariselli, Laura

AU - Tzuk-Shina, Tzahala

AU - Kortmann, Rolf Dieter

AU - Carrie, Christian

AU - Ben Hassel, Mohamed

AU - Kouri, Mauri

AU - Valeinis, Egils

AU - Van Den Berge, Dirk

AU - Collette, Sandra

AU - Collette, Laurence

AU - Mueller, Rolf Peter

PY - 2011/1/10

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N2 - Purpose: This European Organisation for Research and Treatment of Cancer phase III trial assesses whether adjuvant whole-brain radiotherapy (WBRT) increases the duration of functional independence after surgery or radiosurgery of brain metastases. Patients and Methods: Patients with one to three brain metastases of solid tumors (small-cell lung cancer excluded) with stable systemic disease or asymptomatic primary tumors and WHO performance status (PS) of 0 to 2 were treated with complete surgery or radiosurgery and randomly assigned to adjuvant WBRT (30 Gy in 10 fractions) or observation (OBS). The primary end point was time to WHO PS deterioration to more than 2. Results: Of 359 patients, 199 underwent radiosurgery, and 160 underwent surgery. In the radiosurgery group, 100 patients were allocated to OBS, and 99 were allocated to WBRT. After surgery, 79 patients were allocated to OBS, and 81 were allocated to adjuvant WBRT. The median time to WHO PS more than 2 was 10.0 months (95% CI, 8.1 to 11.7 months) after OBS and 9.5 months (95% CI, 7.8 to 11.9 months) after WBRT (P = .71). Overall survival was similar in the WBRT and OBS arms (median, 10.9 v 10.7 months, respectively; P = .89). WBRT reduced the 2-year relapse rate both at initial sites (surgery: 59% to 27%, P <.001; radiosurgery: 31% to 19%, P = .040) and at new sites (surgery: 42% to 23%, P = .008; radiosurgery: 48% to 33%, P = .023). Salvage therapies were used more frequently after OBS than after WBRT. Intracranial progression caused death in 78 (44%) of 179 patients in the OBS arm and in 50 (28%) of 180 patients in the WBRT arm. Conclusion: After radiosurgery or surgery of a limited number of brain metastases, adjuvant WBRT reduces intracranial relapses and neurologic deaths but fails to improve the duration of functional independence and overall survival.

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