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000293801 1001_ $$aEl Shafie, Rami A$$b0
000293801 245__ $$aStereotactic Radiosurgery for 1-10 Brain Metastases to avoid Whole-Brain Radiotherapy - Results of the CYBER-SPACE Randomized Phase 2 Trial.
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000293801 500__ $$a#LA:E050# / Volume 27, Issue 2, February 2025, Pages 479–491
000293801 520__ $$aStereotactic Radiosurgery (SRS) is an emerging alternative to whole-brain radiotherapy (WBRT) for treating multiple brain metastases (BM), reducing toxicity and improving tumor control. The CYBER-SPACE trial compared SRS based on either SPACE or MPRAGE MRI sequence for avoiding or delaying WBRT in patients with 1-10 BM.Patients with 1-10 untreated BM were randomized 1:1 to receive SRS of all lesions based on either SPACE or MPRAGE MRI sequences. If subsequently new BM occurred, SRS was repeated. WBRT was indicated upon occurrence of >10 new BM, leptomeningeal disease or exhausted SRS-radiotolerance. The primary outcome was freedom from WBRT indication (WBRTi). Secondary outcomes included overall survival (OS), safety, and quality of life.202 patients were randomized; SPACE n=99, MPRAGE n=103. 12-month WBRTi-free survival was 77.1% (95%-CI: 69.5%-83.1%) overall, 78.5% (95%-CI: 66.7%-86.5%) for SPACE, and 76.0% (95%-CI: 65.2%-83.9%) for MPRAGE (HR=0.84, 95%-CI: 0.43-1.63, p=0.590). Patients with 5-10 BM had shorter WBRTi-free survival (HR=3.13, 95%-CI: 1.53-6.40, p=0.002). Median OS was 13.1 months overall, 10.5 months for SPACE, and 15.2 months for MPRAGE (HR=1.10, 95%-CI: 0.78-1.56, p=0.585). Neurologic death rate was 10.1%. Predictors for longer OS included Karnofsky Performance Status >80% (HR=0.51, 95%-CI: 0.33-0.77, p=0.002) and concurrent immunotherapy (HR=0.34, 95%-CI: 0.23-0.52, p<0.001).The more sensitive SPACE sequence did not improve outcomes over MPRAGE. SRS with thorough monitoring and immediate re-treatment for new lesions decreases the need for WBRT and achieves low neurologic death rates. SRS should be considered a favorable alternative to WBRT for patients with 1-10 BM.
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000293801 650_7 $$2Other$$aMRI monitoring
000293801 650_7 $$2Other$$aMultiple Brain Metastases
000293801 650_7 $$2Other$$aSPACE sequence
000293801 650_7 $$2Other$$aStereotactic Radiosurgery (SRS)
000293801 650_7 $$2Other$$aWhole-Brain Radiotherapy (WBRT)
000293801 7001_ $$00000-0001-5231-9097$$aBernhardt, Denise$$b1
000293801 7001_ $$aWelzel, Thomas$$b2
000293801 7001_ $$aSchiele, Annabella$$b3
000293801 7001_ $$aSchmitt, Daniela$$b4
000293801 7001_ $$aThalmann, Paul$$b5
000293801 7001_ $$aErdem, Sinem$$b6
000293801 7001_ $$aPaul, Angela$$b7
000293801 7001_ $$aHöne, Simon$$b8
000293801 7001_ $$aLang, Kristin$$b9
000293801 7001_ $$aKönig, Laila$$b10
000293801 7001_ $$aWeykamp, Fabian$$b11
000293801 7001_ $$aAdeberg, Sebastian$$b12
000293801 7001_ $$aLentz-Hommertgen, Adriane$$b13
000293801 7001_ $$aJäkel, Cornelia$$b14
000293801 7001_ $$aBozorgmehr, Farastuk$$b15
000293801 7001_ $$aNestle, Ursula$$b16
000293801 7001_ $$aThomas, Michael$$b17
000293801 7001_ $$aSander, Anja$$b18
000293801 7001_ $$aKieser, Meinhard$$b19
000293801 7001_ $$0P:(DE-He78)8714da4e45acfa36ce87c291443a9218$$aDebus, Jürgen$$b20$$eLast author$$udkfz
000293801 7001_ $$aRieken, Stefan$$b21
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