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. 2022 Nov 2;24(11):1925-1934.
doi: 10.1093/neuonc/noac106.

Factors correlating with survival following adjuvant or definitive radiosurgery for large brain metastases

Enrique Gutiérrez-Valencia  1   2 , Aristotelis Kalyvas  3 , Conrad J Villafuerte  1   2 , Barbara-Ann Millar  1   2 , Normand Laperriere  1   2 , Tatiana Conrad  1   2 , Alejandro Berlin  1   2 , Jessica Weiss  4 , Gelareh Zadeh  3 , Mark Bernstein  3 , Paul Kongkham  3 , David B Shultz  1   2
Affiliations

Factors correlating with survival following adjuvant or definitive radiosurgery for large brain metastases

Enrique Gutiérrez-Valencia et al. Neuro Oncol. .

Abstract

Background: We sought to identify variates correlating with overall survival (OS) in patients treated with surgery (S) plus adjuvant stereotactic radiosurgery (SRS) versus definitive SRS for large (>4 cc) brain metastases (BrM).

Methods: We used univariate (UVA) and multivariate analyses (MVA) to identify survival correlates among eligible patients identified from a prospective registry and compared definitive SRS to S+ adjuvant SRS cohorts using propensity score-matched analysis (PSMA). Secondary outcomes were measured using the cumulative incidence (CI) method.

Results: We identified 364 patients; 127 and 237 were treated with S+SRS and definitive SRS, respectively. On UVA, SRS alone [HR1.73 (1.35,2.22) P < .001), BrM quantity [HR 1.13 (1.06-1.22) (P < .001)]; performance status (PS) [HR 2.78 (1.73-4.46) (P < .001)]; extracranial disease (ECD) [HR 1.82 (1.37,2.40) (P < .001)]; and receipt of systemic treatment after BrM therapy, [HR 0.58 (0.46-073) (P < .001)] correlated with OS. On MVA, SRS alone [HR 1.81 (1.19,2.74) (P < .0054)], SRS target volume [HR 1.03 (1.01,1.06) (P < .0042)], and receipt of systemic treatment [HR 0.68 (0.50,0.93) (P < .015)] correlated with OS. When PSMA was used to balance ECD, BrM quantity, PS, and SRS target volume, SRS alone remained correlated with worsened OS [HR 1.62 (1.20-2.19) (P = 0.0015)]. CI of local failure requiring resection at 12 months was 3% versus 7% for S+SRS and SRS cohorts, respectively [(HR 2.04 (0.89-4.69) (P = .091)]. CI of pachymeningeal failure at 12 months was 16% versus 0% for S+SRS and SRS.

Conclusion: SRS target volume, receipt of systemic therapies, and treatment with S+SRS instead of definitive SRS correlated with improved survival in patients with large BrM.

Keywords: SRS target volume; Surgery; large brain metastases; pachymeningeal failure.

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Figures

Fig. 1
Fig. 1
Overall survival in patients harboring intact brain metastases versus cavities.
Fig. 2
Fig. 2
(a) Cumulative incidence of local failure (LF) requiring surgery in intact brain metastases versus cavities. (b) Cumulative incidence of pachymeningeal failure (PMF) in intact brain metastases versus cavities. (c) Cumulative incidence of leptomeningeal disease (LMD) in intact brain metastases versus cavities.
Fig. 3
Fig. 3
(a) Cumulative incidence of radionecrosis. (b) Cumulative incidence of radionecrosis in intact brain metastases versus cavities. (c) Cumulative incidence of radionecrosis requiring surgery in intact brain metastases versus cavities.
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