Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Feb;26(1):e64-e69.
doi: 10.3747/co.25.4244. Epub 2019 Feb 1.

Factors influencing the outcome of stereotactic radiosurgery in patients with five or more brain metastases

E Hamel-Perreault  1 , D Mathieu  1 , L Masson-Cote  1
Affiliations

Factors influencing the outcome of stereotactic radiosurgery in patients with five or more brain metastases

E Hamel-Perreault et al. Curr Oncol. 2019 Feb.

Abstract

Background: Stereotactic radiosurgery (srs) for patients with 5 or more brain metastases (bmets) is a matter of debate. We report our results with that approach and the factors influencing outcome.

Methods: In the 103 patients who underwent srs for the treatment of 5 or more bmets, primary histology was non-small-cell lung cancer (57% of patients). All patients were grouped by Karnofsky performance status and recursive partitioning analysis (rpa) classification. In our cohort, 72% of patients had uncontrolled extracranial disease, and 28% had stable or responding systemic disease. Previous irradiation for 1-4 bmets had been given to 56 patients (54%). The mean number of treated bmets was 7 (range: 5-19), and the median cumulative bmets volume was 2 cm3 (range: 0.06-28 cm3).

Results: Multivariate analyses showed that stable extracranial disease (p < 0.001) and rpa (p = 0.022) were independent prognostic factors for overall survival (os). Moreover, a cumulative treated bmets volume of less than 6 cm3 (adjusted hazard ratio: 2.54; p = 0.006; 95% confidence interval: 1.30 to 4.99) was associated with better os. The total number of bmets had no effect on survival (p = 0.206). No variable was found to be predictive of local control. The rpa was significant (p = 0.027) in terms of distant recurrence.

Conclusions: Our study suggests that srs is a reasonable option for the management of patients with 5 or more bmets, especially with a cumulative treatment volume of less than 6 cm3.

Keywords: Brain metastasis; Gamma Knife; central nervous system; multiple brain metastases; radiation oncology; stereotactic radiosurgery.

PubMed Disclaimer

Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES We have read and understood Current Oncology’s policy on disclosing conflicts of interest, and we declare that we have none.

Figures

FIGURE 1
FIGURE 1
Kaplan–Meier plot depicting survival rates by the cumulative volume of treated brain metastases (solid line, <6 cm3; dotted line, ≥6 cm3), with log-rank test.
FIGURE 2
FIGURE 2
Kaplan–Meier plot depicting survival rates by the total number of treated brain metastases (solid line, 5–9; dashed line, ≥10), with log-rank test.
See this image and copyright information in PMC

References

    1. Arnold SM, Patchell RA. Diagnosis and management of brain metastases. Hematol Oncol Clin North Am. 2001;15:1085–107. doi: 10.1016/S0889-8588(05)70269-0. - DOI - PubMed
    1. Chang EL, Wefel JS, Hess KR, et al. Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol. 2009;10:1037–44. doi: 10.1016/S1470-2045(09)70263-3. - DOI - PubMed
    1. Tsao MN, Rades D, Wirth A, et al. Radiotherapeutic and surgical management for newly diagnosed brain metastasis(es): an American Society for Radiation Oncology evidence-based guideline. Pract Radiat Oncol. 2012;2:210–25. doi: 10.1016/j.prro.2011.12.004. - DOI - PMC - PubMed
    1. Kaal EC, Niël CG, Vecht CJ. Therapeutic management of brain metastasis. Lancet Neurol. 2005;4:289–98. doi: 10.1016/S1474-4422(05)70072-7. - DOI - PubMed
    1. Lin NU, Lee EQ, Aoyama H, et al. on behalf of the Response Assessment in Neuro-Oncology (rano) group. Response assessment criteria for brain metastases: proposal from the rano group. Lancet Oncol. 2015;16:e270–8. doi: 10.1016/S1470-2045(15)70057-4. - DOI - PubMed