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- Titel:
Stereotactic radiosurgery for 1-10 brain metastases to avoid whole-brain radiotherapy: Results of the CYBER-SPACE randomized phase 2 trial.
- Dokumenttyp:
- Journal Article; Randomized Controlled Trial; Clinical Trial, Phase II
- Autor(en):
- El Shafie, Rami A; Bernhardt, Denise; Welzel, Thomas; Schiele, Annabella; Schmitt, Daniela; Thalmann, Paul; Erdem, Sinem; Paul, Angela; Höne, Simon; Lang, Kristin; König, Laila; Weykamp, Fabian; Adeberg, Sebastian; Lentz-Hommertgen, Adriane; Jäkel, Cornelia; Bozorgmehr, Farastuk; Nestle, Ursula; Thomas, Michael; Sander, Anja; Kieser, Meinhard; Debus, Jürgen; Rieken, Stefan
- Abstract:
- BACKGROUND: Stereotactic radiosurgery (SRS) is an emerging alternative to whole-brain radiotherapy (WBRT) for treating multiple brain metastases (BM), reducing toxicity, and improving tumor control. The CYBER-SPACE trial compared SRS based on either SPACE or MPRAGE MRI sequence for avoiding or delaying WBRT in patients with 1-10 BM. METHODS: Patients with 1-10 untreated BM were randomized 1:1 to receive SRS of all lesions based on either SPACE or MPRAGE MRI sequences. If subsequently new BM occurred, SRS was repeated. WBRT was indicated upon occurrence of >10 new BM, leptomeningeal disease, or exhausted SRS-radiotolerance. The primary outcome was freedom from WBRT indication (WBRTi). Secondary outcomes included overall survival (OS), safety, and quality of life. RESULTS: A total of 202 patients were randomized; SPACE n = 99, MPRAGE n = 103. Twelve-month WBRTi-free survival was 77.1% (95% CI: 69.5%-83.1%) overall, 78.5% (95% CI: 66.7%-86.5%) for SPACE, and 76.0% (95% CI: 65.2%-83.9%) for MPRAGE (hazard ratio [HR] = 0.84, 95% CI: 0.43-1.63, P = .590). Patients with 5-10 BM had shorter WBRTi-free survival (HR = 3.13, 95% CI: 1.53-6.40, P = .002). Median OS was 13.1 months overall, 10.5 months for SPACE, and 15.2 months for MPRAGE (HR = 1.10, 95% CI: 0.78-1.56, P = .585). Neurologic death rate was 10.1%. Predictors for longer OS included Karnofsky Performance Status >80% (HR = 0.51, 95% CI: 0.33-0.77, P = .002) and concurrent immunotherapy (HR = 0.34, 95% CI: 0.23-0.52, P < .001). CONCLUSIONS: The more sensitive SPACE sequence did not improve outcomes over MPRAGE. SRS with thorough monitoring and immediate re-treatment for new lesions decreases the need for WBRT and achieves low neurologic death rates. SRS should be considered a favorable alternative to WBRT for patients with 1-10 BM.
- Zeitschriftentitel:
- Neuro-oncol
- Jahr:
- 2025
- Band / Volume:
- 27
- Heft / Issue:
- 2
- Seitenangaben Beitrag:
- 479-491
- Volltext / DOI:
- doi:10.1093/neuonc/noae201
- PubMed:
- http://view.ncbi.nlm.nih.gov/pubmed/39340439
- Print-ISSN:
- 1522-8517
- TUM Einrichtung:
- Klinik und Poliklinik für RadioOnkologie und Strahlentherapie (Prof. Combs)
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