Multi-institutional Prospective Randomized Comparison of Stereotactic Radiosurgery plus Upfront Whole Brain Radiation Therapy versus Stereotactic Radiosurgery Alone for the treatment of Solitary and Multiple Brain Metastases - Phase III trial between SRS-alone vs. WBRT+SRS for 1-4 brain mets.

Randomized controlled trial of 132 patients with 1 to 4 brain metastases, each less than 3 cm in diameter, randomized between October 1999 and December 2003. Patients were randomized to receive WBRT plus SRS (65 patients) or SRS alone (67 patients) for brain metastases. The median survival time and the 1-year actuarial survival rate were 7.5 months and 38.5% in the WBRT plus SRS arm and 8.0 months in and 28.4% for the SRS-alone arm (P=0.42). The 12-month BTR rate was 46.8% in the WBRT plus SRS arm and 76.4% in the SRS-alone arm (P<0.001). Salvage brain treatment was less frequently required in the WBRT+SRS arm (15%) than in the SRS-alone arm (43%)(P<0.001). Death was attributed to neurologic causes in 22.8% of patients in the WBRT plus SRS arm and in 19.3% of those in the SRS-alone arm. There were no significant differences in systemic and neurologic functional preservation, and radiation toxicity.