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Stereotactic radiosurgery for 1-10 brain metastases to avoid whole-brain radiotherapy: Results of the CYBER-SPACE randomized phase 2 trial

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 delay...

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Main Authors: El-Shafie, Rami (Author) , Bernhardt, Denise (Author) , Welzel, Thomas (Author) , Schiele, Annabella (Author) , Schmitt, Daniela (Author) , Thalmann, Paul (Author) , Erdem, Sinem (Author) , Paul, Angela (Author) , Höne, Simon (Author) , Uzun-Lang, Kristin (Author) , König, Laila (Author) , Weykamp, Fabian (Author) , Adeberg, Sebastian (Author) , Hommertgen, Adriane (Author) , Jäkel, Cornelia (Author) , Bozorgmehr, Farastuk (Author) , Nestle, Ursula (Author) , Thomas, Michael (Author) , Sander, Anja (Author) , Kieser, Meinhard (Author) , Debus, Jürgen (Author) , Rieken, Stefan (Author)
Format: Article (Journal)
Language:English
Published: 2025
In: Neuro-Oncology
Year: 2025, Volume: 27, Issue: 2, Pages: 479-491
ISSN:1523-5866
DOI:10.1093/neuonc/noae201
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1093/neuonc/noae201
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Author Notes:Rami A. El Shafie, Denise Bernhardt, Thomas Welzel, Annabella Schiele, Daniela Schmitt, Paul Thalmann, Sinem Erdem, Angela Paul, Simon Höne, Kristin Lang, Laila König, Fabian Weykamp, Sebastian Adeberg, Adriane Lentz-Hommertgen, Cornelia Jäkel, Farastuk Bozorgmehr, Ursula Nestle, Michael Thomas, Anja Sander, Meinhard Kieser, Jürgen Debus, Stefan Rieken
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Summary: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.
Item Description:Online verfügbar: 28 September 2024
Gesehen am 08.08.2025
Physical Description:Online Resource
ISSN:1523-5866
DOI:10.1093/neuonc/noae201

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