Critical appraisal:Rades D, Sehmisch L, Huttenlocher S, Blank O, Hornung D, Terheyden P, et al 2014

Critical Appraisal

Article being appraised

Rades D, Sehmisch L, Huttenlocher S, Blank O, Hornung D, Terheyden P, et al. Radiosurgery alone for 1-3 newly-diagnosed brain metastases from melanoma: impact of dose on treatment outcomes. Anticancer Res 2014 Sep;34(9):5079-82 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25202094.

Applicable clinical question

When is radiotherapy indicated for patients with distant metastasis?

Key Facts

Study Design

cohort study

Study aims:

To compare different doses of stereotactic radiosurgery for 1-3 newly-diagnosed cerebral metastases from melanoma.

Number of Patients:

54

Forty-four patients were treated with linear accelerator (LINAC)-based radiosurgery and 10 patients with CyberKnife radiosurgery.
Two groups were designed according to the dose administered to the margin of the metastatic lesions: 20 Gy (n=36) and 21-22.5 Gy (n=18).

Reported outcome(s):

Treatment outcomes, including local control of the irradiated metastases, freedom from new brain metastases and overall survival.

Results of outcome(s):

The local control rates of the entire cohort at 6 months and 12 months following SRS were 89% and 81%, respectively.
In univariate analysis, improved local control of the irradiated metastases was significantly associated with SRS doses of 21-22.5 Gy (p= 0.020) and normal pre-radiotherapy LDH levels (p= 0.024).
Local control for SRS dose of 21 Gy was 83% and 72% for 6 month and 12 month respectively; and a SRS dose of 21-22.5 Gy was 100% for local control at 6 and 12 months.

The overall survival rates of the entire cohort at 6 and 12 months following SRS were 67% and 49%, respectively. In the univariate analysis overall survival was not associated with SRS dose (p=0.13). Overall survival for SRS dose of 20 Gy was 64% at 6 months and 42% at 12 months; and for a SRS dose of 21-22.5 Gy the 6 month and 12 month overall survival were 72% and 65%, respectively.

Includes an economic evaluation

no