Longer survival was achieved with stereotactic radiosurgery (SRS) alone than with whole-brain radiation therapy (WBRT) in patients with fewer than 4 brain metastases from non-small cell lung cancer (NSCLC) or breast cancer, a study in the journal Cancer has shown.1

Although use of SRS to treat brain metastases in place of WBRT is increasing, the optimal treatment for these patients remains controversial. In this study, researchers examined the differences in patterns of care at 5 centers before 2010 and overall survival in patients treated with SRS compared with those treated with WBRT.

Study participants were patients with brain metastases from NSCLC initially diagnosed in 2007 to 2009 or breast cancer initially diagnosed in 1997 to 2009. Using propensity score analyses, adjustments were made for confounding factors such as the number of metastases, the extent of extracranial metastases, and the treatment center.

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Of 400 patients with NSCLC and 387 patients with breast cancer, 27.8% and 13.4%, respectively, underwent SRS alone for brain metastases. Among patients with fewer than 4 brain metastases less than 4 cm in size (n = 189 for NSCLC; n = 117 for breast cancer), longer survival was achieved with SRS (adjusted hazard ratio [HR] for NSCLC, 0.58; 95% confidence Interval [CI], 0.38-0.87; P = .01; adjusted HR for breast cancer, 0.54; 95% CI, 0.33-0.91; P = .02) than with WBRT. Few patients with more than 3 brain metastases or lesions 4 cm or larger underwent SRS.


1. Halasz LM, Uno H, Hughes M, et al. Comparative effectiveness of stereotactic radiosurgery versus whole brain radiation therapy for patients with brain metastases from breast or non-small cell lung cancer [published online ahead of print April 18, 2016]. Cancer. doi:10.1002/cncr.30009.