ArticlesWhole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial
Introduction
Brain metastases occur in 20–40% of patients with systemic cancer;1 30–40% present with a single metastasis.2 Outlook for patients is poor with a median survival time of 1–2 months with corticosteroids,3 which can be extended to 6 months with whole brain radiation therapy (WBRT),4, 5 and some investigators6, 7 report that survival can be further lengthened when WBRT is preceded by surgical resection. Originally developed by the Swedish neurosurgeon Lars Leksell,8 radiosurgery is a technique that involves single treatment radiation precisely focused at intracranial targets. Radiosurgery is frequently used to treat brain metastases, sometimes preferred to surgery as a less invasive alternative. We report results of the first multi-institutional prospective randomised comparison of WBRT with or without stereotactic radiosurgery for patients with one to three brain metastases.
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Participants
The study population included patients with confirmed systemic malignant disease. All patients were aged 18 years or older with no previous cranial radiation. Entry criteria included a contrast-enhanced MRI scan showing one to three brain metastases with a maximum diameter of 4 cm for the largest lesion and additional lesions not exceeding 3 cm in diameter.9 Metastases were deemed unresectable if they were located in deep grey matter or in eloquent cortex. Postoperative patients with either
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