The objective of this study was to compare stereotactic radiosurgery (SRS) alone with resection plus whole-brain radiotherapy (WBRT) for the treatment of patients in recursive partitioning analysis (RPA) class 1 and 2 who had 1 or 2 brain metastases. Two hundred six patients in RPA class 1 and 2 who had 1 or 2 brain metastases were analyzed retrospectively. Patients in Group A (n = 94) received from 18 grays (Gy) to 25 Gy SRS, and patients in Group B (n = 112) underwent resection of their metastases and received 10 × 3 Gy/20 × 2 Gy WBRT. Eight other potential prognostic factors were evaluated regarding overall survival (OS), brain control (BC), and local control (LC) of treated metastases: age, sex, performance status, tumor type, number of brain metastases, extracranial metastases, RPA class, and interval from tumor diagnosis to treatment of brain metastases.
 

A comparison of the 2 treatment groups did not reveal significantly different OS (P = .19), BC (P = .52), or LC (P = .25). In RPA subgroup analyses, outcome also did not differ significantly for either RPA class of patients. On multivariate analysis, improved OS was associated with age 60 years (relative risk [RR], 1.75), better performance status (RR, 1.67), no extracranial metastases (RR, 2.84), interval from tumor diagnosis to treatment >12 months (RR, 1.70, and RPA class 1 (RR, 1.51). Improved BC was associated with a single metastasis (RR, 1.54) and an interval from tumor diagnosis to treatment >12 months (RR, 1.58), and improved LC was associated with an interval from tumor diagnosis to treatment >12 months (RR, 1.59).
 

SRS alone appeared to be as effective as resection plus WBRT in the treatment of 1 or 2 brain metastases for patients in RPA class 1 and 2. Patient outcomes were associated with age, Karnofsky performance status, number of brain metastases, extracranial metastases, RPA class, and interval from tumor diagnosis to treatment.