Trial reportInternational journal of radiation oncology, biology, physics2014
Secondary analysis of RTOG 9508, a phase 3 randomized trial of whole-brain radiation therapy versus WBRT plus stereotactic radiosurgery in patients with 1-3 brain metastases; poststratified by the graded prognostic assessment (GPA).
Trial report in International journal of radiation oncology, biology, physics, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 86 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
86 citing papers in PubMed, 4 syntheses or guidelines pooled it, 173 citations in OpenAlex.
- DEGRO guideline for personalized radiotherapy of brain metastases and leptomeningeal carcinomatosis in patients with breast cancer.Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] · 2024Guideline
- Whole Brain Radiation Therapy Plus Stereotactic Radiosurgery in the Treatment of Brain Metastases Leading to Improved Survival in Patients With Favorable Prognostic Factors.Frontiers in oncology · 2019Pooled it
- Whole brain radiotherapy for the treatment of newly diagnosed multiple brain metastases.The Cochrane database of systematic reviews · 2018Pooled it
- Whole brain radiation therapy (WBRT) alone versus WBRT and radiosurgery for the treatment of brain metastases.The Cochrane database of systematic reviews · 2017Pooled it
- Low-dose Gamma Knife radiosurgery plus whole-brain radiation therapy for patients with 5 or more brain metastases with or without meningeal dissemination.International journal of clinical oncology · 2019Trial
- Whole brain radiotherapy and simultaneous integrated boost: is it still a viable treatment for multiple brain metastases in the era of SRS?Reports of practical oncology and radiotherapy : journal of Greatpoland Cancer Center in Poznan and Polish Society of Radiation Oncology · 2026Article
- Neoadjuvant stereotactic radiotherapy for brain metastasis: a review of ongoing clinical trials.Discover oncology · 2025Review
- Normal Brain-Sparing Radiotherapy versus Whole Brain Radiotherapy for Multiple Brain Metastasis from Non-Small Cell Lung Cancer.Cancer research and treatment · 2025Article
- Dosimetric impact of arc simulation angular resolution in single-isocentre multi-target stereotactic radiosurgery.Radiological physics and technology · 2025Article
- Stereotactic Radiosurgery in Multidisciplinary Management of HER2-Positive Gastroesophageal Junction Adenocarcinoma with Large-Brain Metastases: A 9-Year Survival Case.Cancer management and research · 2025Article
- Brain Metastasis in the Emergency Department: Epidemiology, Presentation, Investigations, and Management.Cancers · 2024Review
- Stereotactic Radiosurgery and Stereotactic Fractionated Radiotherapy in the Management of Brain Metastases.Cancers · 2024Review
- Computational markers for personalized prediction of outcomes in non-small cell lung cancer patients with brain metastases.Clinical & experimental metastasis · 2024Article
- Radiotherapy in Preclinical Models of Brain Metastases: A Review and Recommendations for Future Studies.International journal of biological sciences · 2024Review
- Recent trends in radiotherapy use for major cancers in Korea.Japanese journal of clinical oncology · 2023Article
- A Phase 2 Single-Arm Study of Osimertinib for Radiotherapy-Naive Central Nervous System Metastasis NSCLC: Results for the First-Line Cohort of the OCEAN Study (LOGIK 1603/WJOG 9116L).JTO clinical and research reports · 2023Article
- Selecting the Appropriate Radiation Therapy Technique for Extensive Brain Metastases from Tens to Hundreds: Should the Latest Technique Always Be the Best Option?Medicina (Kaunas, Lithuania) · 2023Article
- Article
- Prognostic analysis of stereotactic radiosurgery for brain metastases: a single-center retrospective study.La Radiologia medica · 2023Article
- Single-Isocenter Linac-Based Radiosurgery for Brain Metastases with Coplanar Arcs: A Dosimetric and Clinical Analysis.Cancers · 2023Article
26 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors at 8 institutions in 2 countries.
Funding
Abstract
purposeRadiation Therapy Oncology Group (RTOG) 9508 showed a survival advantage for patients with 1 but not 2 or 3 brain metastasis (BM) treated with whole-brain radiation therapy (WBRT) and stereotactic radiosurgery (SRS) versus WBRT alone. An improved prognostic index, the graded prognostic assessment (GPA) has been developed. Our hypothesis was that if the data from RTOG 9508 were poststratified by the GPA, the conclusions may vary. METHODS AND MATERIALS: In this analysis, 252 of the 331 patients were evaluable by GPA. Of those, 211 had lung cancer. Breast cancer patients were excluded because the components of the breast GPA are not in the RTOG database. Multiple Cox regression was used to compare survival between treatment groups, adjusting for GPA. Treatment comparisons within subgroups were performed with the log-rank test. A free online tool (brainmetgpa.com) simplified GPA use.
resultsThe fundamental conclusions of the primary analysis were confirmed in that there was no survival benefit overall for patients with 1 to 3 metastases; however, there was a benefit for the subset of patients with GPA 3.5 to 4.0 (median survival time [MST] for WBRT + SRS vs WBRT alone was 21.0 versus 10.3 months, P=.05) regardless of the number of metastases. Among patients with GPA 3.5 to 4.0 treated with WBRT and SRS, the MST for patients with 1 versus 2 to 3 metastases was 21 and 14.1 months, respectively.
conclusionsThis secondary analysis of predominantly lung cancer patients, consistent with the original analysis, shows no survival advantage for the group overall when treated with WBRT and SRS; however, in patients with high GPA (3.5-4), there is a survival advantage regardless of whether they have 1, 2, or 3 BM. This benefit did not extend to patients with lower GPA. Prospective validation of this survival benefit for patients with multiple BM and high GPA when treated with WBRT and SRS is warranted.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.