Journal of Radiotherapy

Review Article

Stereotactic Hypofractionated Irradiation for Metastatic, Inoperable, and Recurrent Malignancies: A Modern Necessity, rather than a Luxury

Table 2

Evidence for the integrating stereotactic irradiation with whole-brain RT for brain oligometastases.


Study	Remarks	Conclusions

RTOG 9508 [39]	333 patients with 1–3 randomized to WBRT with or without SRS boost.	Reported improved functional ability in all patients. Survival benefit with SRS boost was limited to patients with single brain metastases. Survival advantage for patients with high graded prognostic assessment scores (3.5–4) irrespective of 1, 2, or 3 brain metastases.

Aoyama et al. [40]	Randomized trial comparing SRS alone or SRS with WBRT in 132 patients with 1–4 brain metastases.	Treatment with SRS alone (without WBRT) would lead to higher risk of intracranial relapse.

Kocher et al. [41]	199 patients with 1–3 brain metastases treated with SRS randomized to observation versus WBRT.	WBRT after SRS reduces risk of intracranial relapse.

Yamamoto et al. [42]	Large study () to assess if SRS alone without WBRT as initial treatment provides similar survival for patients with 5–10 brain metastases compared to patients with 2–4 brain metastases.	SRS alone without WBRT provides noninferior responses in patients with 5–10 brain metastases in comparison to patients with 2–4 brain metastases.

Chang et al. [43]	58 patients with 1–3 brain metastases. To assess cognitive effects of SRS versus SRS plus WBRT.	Patients treated with SRS plus WBRT had greater risk of significant decline in learning and memory functions compared to patients who were treated with SRS alone.

Linskey et al. [37]	Systematic review of trials using SRS with WBRT for newly diagnosed brain metastases.	Derived Level 1 recommendation that single dose SRS along with WBRT leads to significantly longer survival compared to WBRT alone among patients with good performance status (KPS >70) with single metastasis. Also, SRS with WBRT is better than WBRT alone in terms of local control and maintenance of functional status among patients with 1–4 metastases.

Patil et al. [38]	Cochrane Database Systematic Review evaluating the use of WBRT alone versus WBRT with SRS in 358 patients from two trials.	SRT after WBRT reduces local failure (HR 0.27, 95% CI 0.14–0.52) and provides a statistically significant () benefit in improved performance status (43% versus 28% SRS with WBRT versus WBRT alone). Subgroup analysis showed significant overall survival benefits among RPA-1 patients with single metastasis.

SRS: stereotactic radiosurgery; WBRT: whole-brain radiotherapy; RPA: recursive partitioning analysis; HR: hazard ratio; KPS: Karnofsky Performance Status.