A Cochrane review [Abstract] 1 included 3 studies with a total of 195 subjects. The trials compared surgery and whole brain radiation therapy (WBRT) with WBRT alone in patients with single brain metastasis. No significant difference in survival was noted between the treatments (HR 0.74; 95% CI 0.39 to 1.40). One trial has shown surgery and WBRT to increase the duration of functionally independent survival (HR 0.42, 95% CI 0.22 to 0.80). There is a trend for surgery and WBRT to reduce the number of deaths due to neurological cause(OR 0.57, 95% CI 0.29 to 1.10). Adverse effects were not found to be statistically different between the groups.
Comment: The quality of evidence is downgraded by imprecise results (small trials and wide confidence intervals) and indirectness (patients enrolled were not representative of normal patients but highly selected for further therapy).
A Cochrane review[Abstract]2 included 2 trials with a total of 358 participants. The studies compared the efficacy of WBRT plus radiosurgery versus WBRT alone in the treatment of brain metastases.No statistically significant difference was found in overall survival (OS) between WBRT plus radiosurgery and WBRT alone groups (HR = 0.82, 95% CI 0.65 to 1.02). However, for patients with one brain metastasis median survival was significantly longer in WBRT plus radiosurgery group (6.5 months) vs. WBRT group (4.9 months, p=0.04). Patients in the WBRT plus radiosurgery group also had decreased local failure (HR = 0.27, 95% CI 0.14 to 0.52). Furthermore, a statistically significant improvement in performance status scores and decrease in steroid use was seen in the WBRT plus radiosurgery group. Unchanged or improved Karnofsky performance status at 6 months was seen in 43% of patients in the combined therapy group vs. only 28% in WBRT group (p=0.03).
Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment) and imprecise results (limited study size for each comparison)
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