Patients with Long-Term Control of Systemic Disease Are a Favorable Prognostic Group for Treatment of Brain Metastases with Stereotactic Radiosurgery Alone
Department of Radiation Oncology
Neoplasms | Neurosurgery | Oncology | Radiation Medicine
BACKGROUND: Stereotactic radiosurgery (SRS) alone is an attractive option for treatment of brain metastases. SRS avoids whole-brain radiotherapy (WBRT)-associated morbidity, but is limited by regional central nervous system (CNS) failures and short survival in some patients. We evaluated a subgroup of patients with controlled systemic disease that could represent a favorable patient population for SRS alone.
METHODS: All patients with brain metastases treated with SRS without WBRT at our institution between 2004 and 2014 were grouped into two cohorts: those with controlled systemic disease (CSD) for 1 year or longer before prior to presentation with brain metastases and those without (i.e., uncontrolled systemic disease [USD]). Rates of local and regional CNS failure, and overall survival were assessed with chi(2) and Student t tests. Cox regression analysis was performed to evaluate independent predictors of regional control and overall survival.
RESULTS: Two hundred ninety-four patients underwent SRS to 697 lesions, of which 65 patients had CSD. Median follow-up was 9.7 months. There was no difference in local control between the two cohorts (P = 0.795). Regional CNS control was significantly better for patients with CSD (68% vs. 48%; P = 0.001). Overall survival at 1 and 5 years for CSD were 65% and 13% with USD yielding 41% and 7%, respectively (P < 0.001). Multivariate analysis demonstrated that USD (relative CSD) independently predicts regional failure (hazard ratio [HR], 1.75; P = 0.008) and shorter overall survival (HR, 1.55; P = 0.007).
CONCLUSIONS: Patients with brain metastases after 1 year or longer of primary and systemic disease control represent a particularly favorable cohort, with lower regional CNS failure and prolonged survival, for an approach of SRS alone.
Brain metastasis, Gamma knife, Primary disease control, Stereotactic radiosurgery, Systemic disease control
DOI of Published Version
Ebner DK, Gorovets D, Rava P, Cielo D, Kinsella TJ, DiPetrillo TA, Hepel JT. Patients with Long-Term Control of Systemic Disease Are a Favorable Prognostic Group for Treatment of Brain Metastases with Stereotactic Radiosurgery Alone. World Neurosurg. 2017 Feb;98:266-272. doi: 10.1016/j.wneu.2016.11.010. Epub 2016 Nov 9. PMID: 27838432. Link to article on publisher's site
Ebner DK, Gorovets D, Rava P, Cielo D, Kinsella TJ, DiPetrillo TA, Hepel JT. (2017). Patients with Long-Term Control of Systemic Disease Are a Favorable Prognostic Group for Treatment of Brain Metastases with Stereotactic Radiosurgery Alone. Radiation Oncology Publications. https://doi.org/10.1016/j.wneu.2016.11.010. Retrieved from https://escholarship.umassmed.edu/radiationoncology_pubs/113