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N0574 showed that adding whole-brain radiotherapy to radiosurgery for a few brain metastases damages memory and thinking without lengthening life, and radiosurgery alone became the standard.
N0574 randomised 213 patients with one to three brain metastases to stereotactic radiosurgery alone or radiosurgery plus whole-brain radiotherapy. Cognitive deterioration at three months, the primary endpoint, occurred in 63.5 percent after radiosurgery alone and 91.7 percent after the combination; whole-brain treatment improved intracranial control but median survival did not differ (10.4 vs 7.4 months, not significant) (Brown and colleagues, JAMA 2016).
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
213 enrolled.
| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Cognitive deterioration at 3 monthsprimary | Radiosurgery alone | 111 | 63.5% | - | - | - |
| Radiosurgery plus whole-brain radiotherapy | 102 | 91.7% |
Shares Whole-brain radiotherapy (WBRT), Brain metastases (secondary brain tumours), Brain and spinal cord tumours (all types), Metastatic cancer (cancer that has spread) and the tag radiation-wave2.
Shares Whole-brain radiotherapy (WBRT), Brain metastases (secondary brain tumours), Brain and spinal cord tumours (all types) and the tag radiation-wave2.
Shares Brain and spinal cord tumours (all types) and the tag radiation-wave2.
Shares Alliance for Clinical Trials in Oncology and the tag radiation-wave2.
Shares Alliance N0574: radiosurgery alone versus radiosurgery plus whole-brain radiotherapy for one to three brain metastases, Brain metastases (secondary brain tumours), Brain and spinal cord tumours (all types).
Shares Whole-brain radiotherapy (WBRT), HER2-positive breast cancer with brain metastases, Brain metastases (secondary brain tumours), Metastatic cancer (cancer that has spread).
Shares Stereotactic radiosurgery (SRS), HER2-positive breast cancer with brain metastases, Brain metastases (secondary brain tumours).
Shares Stereotactic radiosurgery (SRS), Stereotactic radiosurgery (Gamma Knife, CyberKnife, linac SRS), Brain and spinal cord tumours (all types), Metastatic cancer (cancer that has spread).