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. 2024 May 28;31(6):2994-3005.
doi: 10.3390/curroncol31060228.

Survival after Stereotactic Radiosurgery in the Era of Targeted Therapy: Number of Metastases No Longer Matters

James de Boisanger  1   2 , Martin Brewer  1 , Matthew W Fittall  3 , Amina Tran  1 , Karen Thomas  1 , Sabine Dreibe  1 , Antonia Creak  1 , Francesca Solda  1 , Jessica Konadu  1 , Helen Taylor  1 , Frank Saran  4 , Liam Welsh  1 , Nicola Rosenfelder  1
Affiliations

Survival after Stereotactic Radiosurgery in the Era of Targeted Therapy: Number of Metastases No Longer Matters

James de Boisanger et al. Curr Oncol. .

Abstract

Randomised control trial data support the use of stereotactic radiosurgery (SRS) in up to 4 brain metastases (BMs), with non-randomised prospective data complementing this for up to 10 BMs. There is debate in the neuro-oncology community as to the appropriateness of SRS in patients with >10 BMs. We present data from a large single-centre cohort, reporting survival in those with >10 BMs and in a >20 BMs subgroup. A total of 1181 patients receiving SRS for BMs were included. Data were collected prospectively from the time of SRS referral. Kaplan-Meier graphs and logrank tests were used to compare survival between groups. Multivariate analysis was performed using the Cox proportional hazards model to account for differences in group characteristics. Median survival with 1 BM (n = 379), 2-4 BMs (n = 438), 5-10 BMs (n = 236), and >10 BMs (n = 128) was 12.49, 10.22, 10.68, and 10.09 months, respectively. Using 2-4 BMs as the reference group, survival was not significantly different in those with >10 BMs in either our univariable (p = 0.6882) or multivariable analysis (p = 0.0564). In our subgroup analyses, median survival for those with >20 BMs was comparable to those with 2-4 BMs (10.09 vs. 10.22 months, p = 0.3558). This study contributes a large dataset to the existing literature on SRS for those with multi-metastases and supports growing evidence that those with >10 BMs should be considered for SRS.

Keywords: brain metastases; number of metastases; stereotactic radiosurgery.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier curve presenting survival according to no. of BM groups.
Figure 2
Figure 2
Multivariable analysis. Forest plot and table presenting the variables included in the analysis and their intra-group pair comparisons and inter-group likelihood ratio p-value results.
Figure 3
Figure 3
(a) Kaplan–Meier curve presenting survival in those with breast cancer and >10 BMs compared to those with a GI primary and a solitary BM. (b) Kaplan–Meier curve presenting survival in those with a driver mutation and >10 BMs compared to those without a driver mutation and a solitary BM.
Figure 4
Figure 4
Kaplan–Meier curve demonstrating survival of those with targetable molecular alterations (EGFR, ALK, BRAF, and HER2) and those without.
Figure 5
Figure 5
(a) Range and distribution of BM number in the >10 BMs group. (b) Kaplan–Meier curve presenting survival according to no. of BM groups, including the >20 BMs subgroup.
See this image and copyright information in PMC

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