Comparative Efficacy of Stereotactic Radiotherapy and Whole-Brain Radiotherapy

Overview

This study evaluates the efficacy and safety of stereotactic radiotherapy (SRT) plus immunotherapy versus whole-brain radiotherapy (WBRT) plus immunotherapy in patients with driver gene-negative non-small cell lung cancer (NSCLC) and brain metastases.

Background

Brain metastases are a common complication in non-small cell lung cancer (NSCLC) and are associated with poor prognosis. The integration of immune checkpoint inhibitors with radiotherapy presents a new treatment avenue, yet comparative studies between WBRT and SRT are lacking.

Data Highlights

Key Findings

• SRT+I resulted in a median overall survival of 29.3 months compared to 19.9 months for WBRT+I (P = 0.034).
• Intracranial progression-free survival was significantly longer in the SRT+I group (14.7 months) than in the WBRT+I group (9.4 months, P = 0.038).
• The intracranial objective response rate was higher in the SRT+I group (78.6%) compared to the WBRT+I group (61.5%).
• The disease control rate was also superior in the SRT+I group (95.0%) compared to the WBRT+I group (88.5%).
• Radiation-induced brain injury occurred less frequently in the SRT+I group (3.75%) than in the WBRT+I group (10.26%).
• No grade ≥3 immune-related adverse events were reported in the SRT+I group.

Clinical Implications

The findings provide data on survival outcomes and toxicity for SRT combined with immunotherapy versus WBRT with immunotherapy in patients with driver gene-negative NSCLC and brain metastases.

Conclusion

SRT+I demonstrates efficacy in terms of survival and disease control compared to WBRT+I for patients with driver-gene-negative NSCLC and brain metastases.

Related Resources & Content

1. The ASCO Post, 2016 -- Which Factors Influence Radiotherapy for Brain Metastases?
2. The ASCO Post, 2026 -- Stereotactic vs Whole-Brain Radiation for Patients With Brain Metastases
3. Treatment for Brain Metastases: ASCO-SNO-ASTRO Guideline - PMC, 2021
4. Hippocampal Avoidance During Whole-Brain Radiotherapy Plus Memantine for Patients With Brain Metastases: Phase III Trial NRG Oncology CC001 - PMC, 2021
5. The ASCO Post — Stereotactic vs Whole-Brain Radiation for Patients With Brain Metastases
6. the asco post — Stereotactic vs Whole-Brain Radiation for Patients With Brain Metastases
7. Treatment for Brain Metastases: ASCO-SNO-ASTRO Guideline - PMC
8. Hippocampal Avoidance During Whole-Brain Radiotherapy Plus Memantine for Patients With Brain Metastases: Phase III Trial NRG Oncology CC001 - PMC
9. First-line immunotherapy ± chemotherapy with or without upfront stereotactic radiotherapy (SRT) in patients with Non-Small cell lung cancer (NSCLC) with asymptomatic brain metastases - Lung Cancer