Alliance N0574: radiosurgery alone versus radiosurgery plus whole-brain radiotherapy for one to three brain metastases
Adding whole-brain radiotherapy to focused radiosurgery for a few brain metastases caused more memory and thinking problems without lengthening life, so radiosurgery alone became standard for limited brain metastases.
Overview
Phase 3 trial of 213 patients with one to three brain metastases randomised to stereotactic radiosurgery alone or radiosurgery plus whole-brain radiotherapy, with cognitive decline at three months as the primary endpoint.
Cognitive deterioration was more frequent with whole-brain radiotherapy (91.7 versus 63.5 percent) despite better intracranial control, and median overall survival did not differ (10.4 versus 7.4 months, not significant).
- Cognitive deterioration at three months 91.7 percent vs 63.5 percent.
- Intracranial control at one year better with whole-brain radiotherapy (85 vs 51 percent) without a survival difference.
Patients with a limited number of brain metastases are treated with radiosurgery alone and surveillance, accepting more new brain lesions in return for preserved cognition.
- Cognitive testing only assessed to three months in the primary endpoint.
- Modern hippocampal-avoidance whole-brain radiotherapy was not used.
Similar pages
not linked directly; found by shared links- TermStereotactic radiosurgery (SRS)
Shares Alliance N0574 (NCCTG N0574), Brain metastases (secondary brain tumours).
- TermWhole-brain radiotherapy (WBRT)
Shares Alliance N0574 (NCCTG N0574), Brain metastases (secondary brain tumours).
- CancerHER2-positive breast cancer with brain metastases
Shares Alliance N0574 (NCCTG N0574), Brain metastases (secondary brain tumours).