Outcomes of stereotactic radiosurgery of brain metastases from neuroendocrine tumors

Abstract

Background: Stereotactic radiosurgery (SRS) is an established treatment for brain metastases, yet little is known about SRS for neuroendocrine tumors given their unique natural history.

Objective: To determine outcomes and toxicity from SRS in patients with brain metastases arising from neuroendocrine tumors.

Methods: Thirty-three patients with brain metastases from neuroendocrine tumors who underwent SRS were retrospectively reviewed. Median age was 61 years and median Karnofsky performance status was 80. Primary sites were lung (87.9%), cervix (6.1%), esophagus (3%), and prostate (3%). Ten patients (30.3%) received upfront SRS, 7 of whom had neuroendocrine tumors other than small cell lung carcinoma. Kaplan-Meier survival and Cox regression analyses were performed to determine prognostic factors for survival.

Results: With median follow-up after SRS of 5.3 months, local and distant brain recurrence developed in 5 patients (16.7%) and 20 patients (66.7%), respectively. Median overall survival (OS) after SRS was 6.9 months. Patients with progressive disease per Response Assessment in Neuro-Oncology-Brain Metastases (RANO-BM) criteria at 4 to 6 weeks after SRS had shorter median time to developing recurrence at a distant site in the brain and shorter OS than patients without progressive disease: 1.4 months and 3.3 months vs 11.4 months and 12 months, respectively (both P < .001). Toxicity was more likely in lesions of small cell histology than in lesions of other neuroendocrine tumor histology, 15.7% vs 3.3% (P = .021). No cases of grade 3 to 5 necrosis occurred.

Conclusions: SRS is an effective treatment option for patients with brain metastases from neuroendocrine tumors with excellent local control despite slightly higher toxicity rates than expected. Progressive disease at 4 to 6 weeks after SRS portends a poor prognosis.

Keywords: Gamma Knife; brain metastases; neuroendocrine; small cell carcinoma; stereotactic radiosurgery.

Fig. 1

(A) Overall survival by treatment group. (B) Overall survival by histology. (C) Distant-brain-recurrence free survival by RANO-BM progression at 4 to 6 weeks after SRS. (D) Overall survival by RANO-BM progression at 4 to 6 weeks after SRS. Abbreviations: NET, neuroendocrine tumor; PCI, prophylactic cranial irradiation; RANO-BM, Response Assessment in Neuro-Oncology-Brain Metastases; SRS, stereotactic radiosurgery; WBRT, whole brain radiation therapy.