TY - JOUR
T1 - Local Control and Survival Outcomes After Stereotactic Radiosurgery for Brain Metastases From Gastrointestinal Primaries
T2 - An International Multicenter Analysis
AU - Singh, Raj
AU - Bowden, Greg
AU - Mathieu, David
AU - Perlow, Haley K.
AU - Palmer, Joshua D.
AU - Elhamdani, Shahed
AU - Shepard, Matthew
AU - Liang, Yun
AU - Nabeel, Ahmed M.
AU - Reda, Wael A.
AU - Tawadros, Sameh R.
AU - Abdelkarim, Khaled
AU - El-Shehaby, Amr M.N.
AU - Emad, Reem M.
AU - Elazzazi, Ahmed Hesham
AU - Warnick, Ronald E.
AU - Gozal, Yair M.
AU - Daly, Megan
AU - McShane, Brendan
AU - Addis-Jackson, Marcel
AU - Karthikeyan, Gokul
AU - Smith, Sian
AU - Picozzi, Piero
AU - Franzini, Andrea
AU - Kaisman-Elbaz, Tehila
AU - Yang, Huai Che
AU - Wei, Zhishuo
AU - Legarreta, Andrew
AU - Hess, Judith
AU - Templeton, Kelsey
AU - Pikis, Stylianos
AU - Mantziaris, Georgios
AU - Simonova, Gabriela
AU - Liscak, Roman
AU - Peker, Selcuk
AU - Samanci, Yavuz
AU - Chiang, Veronica
AU - Niranjan, Ajay
AU - Kersh, Charles R.
AU - Lee, Cheng Chia
AU - Trifiletti, Daniel M.
AU - Lunsford, L. Dade
AU - Sheehan, Jason P.
N1 - Publisher Copyright:
© 2023 Congress of Neurological Surgeons. All rights reserved.
PY - 2023/9/1
Y1 - 2023/9/1
N2 - BACKGROUND: There are limited data regarding outcomes for patients with gastrointestinal (GI) primaries and brain metastases treated with stereotactic radiosurgery (SRS). OBJECTIVE: To examine clinical outcomes after SRS for patients with brain metastases from GI primaries and evaluate potential prognostic factors. METHODS: The International Radiosurgery Research Foundation centers were queried for patients with brain metastases from GI primaries managed with SRS. Primary outcomes were local control (LC) and overall survival (OS). Kaplan-Meier analysis was used for univariate analysis (UVA) of prognostic factors. Factors significant on UVA were evaluated with a Cox multivariate analysis proportional hazards model. Logistic regressions were used to examine correlations with RN. RESULTS: We identified 263 eligible patients with 543 brain metastases. Common primary sites were rectal (31.2%), colon (31.2%), and esophagus (25.5%) with a median age of 61.6 years (range: 37-91.4 years) and a median Karnofsky performance status (KPS) of 90% (range: 40%-100%). One-year and 2-year LC rates were 83.5% (95% CI: 78.9%-87.1%) and 73.0% (95% CI: 66.4%-78.5%), respectively. On UVA, age >65 years (P =.001), dose <20 Gy (P =.006) for single-fraction plans, KPS <90% (P <.001), and planning target volume ≥2cc (P =.007) were associated with inferior LC. All factors other than dose were significant on multivariate analysis (P ≤.002). One-year and 2-year OS rates were 68.0% (95% CI: 61.5%-73.6%) and 31.2% (95% CI: 24.6%-37.9%), respectively. Age > 65 years (P =.006), KPS <90% (P =.005), and extracranial metastases (P =.05) were associated with inferior OS. CONCLUSION: SRS resulted in comparable LC with common primaries. Age and KPS were associated with both LC and OS with planning target volume and extracranial metastases correlating with LC and OS, respectively. These factors should be considered in GI cancer patient selection for SRS.
AB - BACKGROUND: There are limited data regarding outcomes for patients with gastrointestinal (GI) primaries and brain metastases treated with stereotactic radiosurgery (SRS). OBJECTIVE: To examine clinical outcomes after SRS for patients with brain metastases from GI primaries and evaluate potential prognostic factors. METHODS: The International Radiosurgery Research Foundation centers were queried for patients with brain metastases from GI primaries managed with SRS. Primary outcomes were local control (LC) and overall survival (OS). Kaplan-Meier analysis was used for univariate analysis (UVA) of prognostic factors. Factors significant on UVA were evaluated with a Cox multivariate analysis proportional hazards model. Logistic regressions were used to examine correlations with RN. RESULTS: We identified 263 eligible patients with 543 brain metastases. Common primary sites were rectal (31.2%), colon (31.2%), and esophagus (25.5%) with a median age of 61.6 years (range: 37-91.4 years) and a median Karnofsky performance status (KPS) of 90% (range: 40%-100%). One-year and 2-year LC rates were 83.5% (95% CI: 78.9%-87.1%) and 73.0% (95% CI: 66.4%-78.5%), respectively. On UVA, age >65 years (P =.001), dose <20 Gy (P =.006) for single-fraction plans, KPS <90% (P <.001), and planning target volume ≥2cc (P =.007) were associated with inferior LC. All factors other than dose were significant on multivariate analysis (P ≤.002). One-year and 2-year OS rates were 68.0% (95% CI: 61.5%-73.6%) and 31.2% (95% CI: 24.6%-37.9%), respectively. Age > 65 years (P =.006), KPS <90% (P =.005), and extracranial metastases (P =.05) were associated with inferior OS. CONCLUSION: SRS resulted in comparable LC with common primaries. Age and KPS were associated with both LC and OS with planning target volume and extracranial metastases correlating with LC and OS, respectively. These factors should be considered in GI cancer patient selection for SRS.
KW - Brain metastases
KW - Gastrointestinal primary
KW - Local control
KW - Overall survival
KW - Radionecrosis
KW - Stereotactic radiosurgery
UR - http://www.scopus.com/inward/record.url?scp=85162747671&partnerID=8YFLogxK
U2 - 10.1227/neu.0000000000002456
DO - 10.1227/neu.0000000000002456
M3 - Article
C2 - 36942965
AN - SCOPUS:85162747671
SN - 0148-396X
VL - 93
SP - 592
EP - 598
JO - Neurosurgery
JF - Neurosurgery
IS - 3
ER -
