Home > Publications database > Stereotactic Radiosurgery for 1-10 Brain Metastases to avoid Whole-Brain Radiotherapy - Results of the CYBER-SPACE Randomized Phase 2 Trial. > print

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005     20250212162621.0
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082 _ _ |a 610
100 1 _ |a El Shafie, Rami A
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245 _ _ |a Stereotactic Radiosurgery for 1-10 Brain Metastases to avoid Whole-Brain Radiotherapy - Results of the CYBER-SPACE Randomized Phase 2 Trial.
260 _ _ |a Oxford
|c 2025
|b Oxford Univ. Press
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500 _ _ |a #LA:E050# / Volume 27, Issue 2, February 2025, Pages 479–491
520 _ _ |a 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.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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650 _ 7 |a MRI monitoring
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650 _ 7 |a Multiple Brain Metastases
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650 _ 7 |a SPACE sequence
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650 _ 7 |a Stereotactic Radiosurgery (SRS)
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650 _ 7 |a Whole-Brain Radiotherapy (WBRT)
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700 1 _ |a Bernhardt, Denise
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700 1 _ |a Welzel, Thomas
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700 1 _ |a Schiele, Annabella
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700 1 _ |a Schmitt, Daniela
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700 1 _ |a Thalmann, Paul
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700 1 _ |a Erdem, Sinem
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700 1 _ |a Paul, Angela
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700 1 _ |a Höne, Simon
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700 1 _ |a Lang, Kristin
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700 1 _ |a König, Laila
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700 1 _ |a Weykamp, Fabian
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700 1 _ |a Adeberg, Sebastian
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700 1 _ |a Lentz-Hommertgen, Adriane
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700 1 _ |a Jäkel, Cornelia
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700 1 _ |a Bozorgmehr, Farastuk
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700 1 _ |a Nestle, Ursula
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700 1 _ |a Thomas, Michael
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700 1 _ |a Sander, Anja
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700 1 _ |a Kieser, Meinhard
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700 1 _ |a Debus, Jürgen
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700 1 _ |a Rieken, Stefan
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