Local Control and Survival Outcomes After Stereotactic Radiosurgery for Brain Metastases From Gastrointestinal Primaries: An International Multicenter Analysis

Raj Singh¹, Greg Bowden², David Mathieu³, Haley K Perlow⁴, Joshua D Palmer⁴, Shahed Elhamdani⁵, Matthew Shepard⁵, Yun Liang⁶, Ahmed M Nabeel^{7

8}, Wael A Reda^{7

9}, Sameh R Tawadros^{7

9}, Khaled Abdelkarim^{7

10}, Amr M N El-Shehaby^{7

9}, Reem M Emad^{7

11}, Ahmed Hesham Elazzazi¹², Ronald E Warnick¹³, Yair M Gozal¹³, Megan Daly¹⁴, Brendan McShane¹⁴, Marcel Addis-Jackson¹⁴, Gokul Karthikeyan¹⁴, Sian Smith¹⁴, Piero Picozzi¹⁵, Andrea Franzini¹⁵, Tehila Kaisman-Elbaz¹⁶, Huai-Che Yang^{17

18}, Zhishuo Wei¹⁹, Andrew Legarreta¹⁹, Judith Hess²⁰, Kelsey Templeton²⁰, Stylianos Pikis²¹, Georgios Mantziaris²¹, Gabriela Simonova²², Roman Liscak²², Selcuk Peker²³, Yavuz Samanci²³, Veronica Chiang²⁰, Ajay Niranjan¹⁹, Charles R Kersh²⁴, Cheng-Chia Lee^{17

18}, Daniel M Trifiletti²⁵, L Dade Lunsford¹⁹, Jason P Sheehan²¹

Affiliations

¹ Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, Virginia, USA.
² Department of Neurosurgery, University of Alberta, Edmonton, Canada.
³ Department of Neurosurgery, Université de Sherbrooke, Sherbrooke, Canada.
⁴ Departments of Radiation Oncology and Neurosurgery, The James Cancer Hospital and Solove Research Institute, Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
⁵ Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
⁶ Department of Radiation Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
⁷ Department of Neurosurgery, Gamma Knife Center, Nasser Institute Hospital, Cairo, Egypt.
⁸ Department of Neurosurgery, Benha University, Banha, Egypt.
⁹ Department of Neurosurgery, Ain Shams University, Cairo, Egypt.
¹⁰ Department of Clinical Oncology, Ain Shams University, Cairo, Egypt.
¹¹ Department of Radiation Oncology, National Cancer Institute, Cairo University, Giza City, Egypt.
¹² Ain Shams University, Cairo, Egypt.
¹³ Department of Neurosurgery, Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati, Ohio, USA.
¹⁴ Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
¹⁵ Department of Neurosurgery, Humanitas Research Hospital - IRCCS, Rozzano, Italy.
¹⁶ Department of Neurosurgery, Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
¹⁷ Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, China.
¹⁸ Department of Neurosurgery, National Yang Ming Chiao Tung University School of Medicine, Taipei, China.
¹⁹ Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
²⁰ Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.
²¹ Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.
²² Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czechia.
²³ Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey.
²⁴ Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia, USA.
²⁵ Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, Florida, USA.

PMID: 36942965
DOI: 10.1227/neu.0000000000002456

Multicenter Study

Local Control and Survival Outcomes After Stereotactic Radiosurgery for Brain Metastases From Gastrointestinal Primaries: An International Multicenter Analysis

Raj Singh et al. Neurosurgery. 2023.

. 2023 Sep 1;93(3):592-598.

doi: 10.1227/neu.0000000000002456. Epub 2023 Mar 21.

Authors

Affiliations

¹ Department of Radiation Oncology, Virginia Commonwealth University Health System, Richmond, Virginia, USA.
² Department of Neurosurgery, University of Alberta, Edmonton, Canada.
³ Department of Neurosurgery, Université de Sherbrooke, Sherbrooke, Canada.
⁴ Departments of Radiation Oncology and Neurosurgery, The James Cancer Hospital and Solove Research Institute, Ohio State University Wexner Medical Center, Columbus, Ohio, USA.
⁵ Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
⁶ Department of Radiation Oncology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.
⁷ Department of Neurosurgery, Gamma Knife Center, Nasser Institute Hospital, Cairo, Egypt.
⁸ Department of Neurosurgery, Benha University, Banha, Egypt.
⁹ Department of Neurosurgery, Ain Shams University, Cairo, Egypt.
¹⁰ Department of Clinical Oncology, Ain Shams University, Cairo, Egypt.
¹¹ Department of Radiation Oncology, National Cancer Institute, Cairo University, Giza City, Egypt.
¹² Ain Shams University, Cairo, Egypt.
¹³ Department of Neurosurgery, Gamma Knife Center, Jewish Hospital, Mayfield Clinic, Cincinnati, Ohio, USA.
¹⁴ Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
¹⁵ Department of Neurosurgery, Humanitas Research Hospital - IRCCS, Rozzano, Italy.
¹⁶ Department of Neurosurgery, Rose Ella Burkhart Brain Tumor and Neuro-Oncology Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, USA.
¹⁷ Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, China.
¹⁸ Department of Neurosurgery, National Yang Ming Chiao Tung University School of Medicine, Taipei, China.
¹⁹ Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
²⁰ Department of Neurosurgery, Yale University School of Medicine, New Haven, Connecticut, USA.
²¹ Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.
²² Department of Stereotactic and Radiation Neurosurgery, Na Homolce Hospital, Prague, Czechia.
²³ Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey.
²⁴ Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia, USA.
²⁵ Department of Radiation Oncology, Mayo Clinic Florida, Jacksonville, Florida, USA.

PMID: 36942965
DOI: 10.1227/neu.0000000000002456

Abstract

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.

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References

1. Johnson JD, Young B. Demographics of brain metastasis. Neurosurg Clin N Am 1996;7(3):337-344.
1. Nayak L, Lee EQ, Wen PY. Epidemiology of brain metastases. Curr Oncol Rep. 2012;14(1):48-54.
1. Fox BD, Cheung VJ, Patel AJ, Suki D, Rao G. Epidemiology of metastatic brain tumors. Neurosurg Clin N Am. 2011; 22(1):1-6,
1. Singh R, Stoltzfus KC, Chen H, et al. Epidemiology of synchronous brain metastases. Neurooncol Adv. 2020; 2(1):vdaa041.
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Local Control and Survival Outcomes After Stereotactic Radiosurgery for Brain Metastases From Gastrointestinal Primaries: An International Multicenter Analysis

Affiliations

Local Control and Survival Outcomes After Stereotactic Radiosurgery for Brain Metastases From Gastrointestinal Primaries: An International Multicenter Analysis

Authors

Affiliations

Abstract

References

Publication types

MeSH terms