RADT-01. COMPARATIVE STUDY OF LOCAL CONTROL FOR BRAIN METASTASIS BETWEEN PRE-FRAME AND POST-FRAME MRI METHODS OF GAMMA KNIFE STEREOTACTIC RADIOSURGERY

Abstract INTRODUCTION Gamma Knife radiosurgery (GKRS) is an established treatment modality in the management of brain metastasis (BM). The standard treatment flow includes frame placement followed by obtaining a post-frame MRI for planning. However, there has been a shift in practice towards using the pre-frame MRI method. It shortens the frame-wearing time while improving quality of imaging/targeting by decreasing artifacts by screws. However, no previous studies have compared the GKRS outcome between the pre- and post-frame MRI methods. METHODS 134 patients (61 pre-frame and 73 post-frame) with 307 BMs treated with first time GKRS were reviewed retrospectively. We defined local failure (LF) as ≥ 20% increase in maximum diameter (RECIST criteria). Kaplan-Meier and Gray’s method were used to estimate and compare cumulative incidence rate of LF between the groups; multivariable analysis for time-to-local failure (TTLF) was performed using Cox frailty model. The number of lesions was intrinsically modeled in frailty model. RESULTS There was no significant difference between the groups for background variables including age, gender, primary cancer, performance status, and number of lesions. Post-frame group had significantly smaller tumors at baseline (p=0.004). The cumulative incidence rates of LF for pre- vs post-frame groups were 1.6% vs 5.5% at 6 month, 6.9% vs 9.9% at 12 month, and 10.4% vs 17.4% at 24 month, respectively, without significant differences (p=0.84). Using multivariate frailty Cox model adjusting for age, gender, and lesion size, extracranial metastasis (HR 4.13, 95%CI 1.48‒11.57, p=0.007) was the significant prognostic factor for TTLF, while the frame type was not significant (p=0.46). CONCLUSIONS This is the first report comparing the GKRS outcome of pre- and post-frame MRI methods. The results indicated that pre-frame MRI method conveys a comparable local control for BM while maintaining practical benefits such as shortened frame-wearing time, less-artifact imaging, and longer preparation time available for planning.

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RADI-05. FRACTIONATED TREATMENT OF BRAIN METASTASES WITH GAMMA KNIFE ICON

Neuro-Oncology Advances ◽

10.1093/noajnl/vdz014.098 ◽

2019 ◽

Vol 1 (Supplement_1) ◽

pp. i22-i22

Author(s):

Jameson Mendel ◽

Ankur Patel ◽

Toral Patel ◽

Robert Timmerman ◽

Tu Dan ◽

...

Keyword(s):

Brain Metastasis ◽

Brain Metastases ◽

Gamma Knife ◽

Local Control ◽

Stereotactic Radiotherapy ◽

Tumor Volume ◽

Univariate Analysis ◽

Local Failure ◽

Fractionated Stereotactic Radiotherapy

Abstract PURPOSE/OBJECTIVE(S): Stereotactic radiosurgery with Gamma Knife is a common treatment modality for patients with brain metastasis. The Gamma Knife ICON allows for immobilization with an aquaplast mask, permitting fractionated treatments. We describe one of the first experiences utilizing this technique with brain metastasis and evaluate outcomes. MATERIALS/METHODS: From June 2017 to November 2018, 29 patients with 43 separate intracranial lesions were treated with fractionated stereotactic radiotherapy using the gamma knife ICON at a single institution. Patients received between 20–30 Gy in 3–5 fractions with no margin over the course of 5 to 23 days. Local control was physician assessed. Local failure over time was modeled using cumulative incidence; lesions were censored at last radiographic follow up. RESULTS: Median tumor volume and prescription isodose was 7.7 cm3 (range 0.3–43.9) and 50% (range 40–65), respectively. Median radiographic follow-up was 7 months and median survival was 9 months. Radiation necrosis occurred in 3/3 patients treated with 27 Gy in 3 fractions, one requiring therapeutic resection. Incidence of local failure for all treated lesions was 9% at 1 year. Tumor volume >7 cm3 was associated with local failure on univariate analysis (p=0.025). 100% (2/2) lesions treated with 20 Gy in 5 fractions developed local recurrence. CONCLUSION: Fractionated stereotactic radiotherapy with the Gamma Knife ICON provides excellent local control for small and large brain metastases with minimal toxicity. Tumors >7 cm3 should receive at least 30 Gy in 5 fractions for optimal control. Treatment with 27 Gy in 3 fractions appears to have high rates of treatment related toxicity and should be avoided.

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Risk factors for unplanned removal of central venous catheters in hospitalized children with hematological and oncological disorders

10.22541/au.160645869.93914774/v1 ◽

2020 ◽

Author(s):

Moe Miyagishima ◽

Hamada Motoharu ◽

Yuji Hirayama ◽

Hideki Muramatsu ◽

Takahisa Tainaka ◽

...

Keyword(s):

Risk Factors ◽

Cumulative Incidence ◽

Pediatric Patients ◽

Cohort Analysis ◽

Multivariable Analysis ◽

Central Line ◽

Central Venous Catheters ◽

Central Venous ◽

Subdistribution Hazard ◽

Significant Difference

Background: Central venous catheters (CVCs) have been essential devices for the treatment of children with hematological and oncological disorders. Only few studies investigated the complications and selections of different types of CVCs in these pediatric patients. This study aimed to compare risk factors for unplanned removal of two commonly used CVCs, i.e., peripherally inserted central catheters (PICCs) and tunneled CVCs, and propose better device selection for the patient. Procedure: This retrospective, single center cohort analysis was conducted on pediatric patients with hematological and oncological disorders inserted with either a PICC or a tunneled CVC. Results: Between January 1, 2013, and December 31, 2015, 89 patients inserted with tunneled CVCs (total 21,395 catheter-days) and 84 with PICCs (total 9,177 catheter-days) were followed up until the catheter removal. The median duration of catheterization was 88 days in PICCs and 186 days in tunneled CVCs (p = 1.24×10-9). PICCs at the 3-month cumulative incidence of catheter occlusion (5.2% vs. 0%, p = 4.08×10-3) and total unplanned removal (29.0% vs 7.0%, p = 0.0316) were significantly higher, whereas no significant difference was observed in the cumulative incidence of central line-associated bloodstream infection (11.8% vs. 2.3%, p = 0.664). Multivariable analysis identified younger age (<2 years) (subdistribution hazard ratio [SHR], 2.29; 95% confidence interval [CI], 1.27–4.14) and PICCs (SHR, 2.73; 95% CI, 1.48–5.02) were independent risk factors for unplanned removal. Conclusion: Our results suggest that tunnel CVCs would be a preferred device for children with hematological and oncological disorders requiring long-term, intensive treatment.

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Evaluation of local control in patients with non-metastatic Ewing sarcoma of the bone: A report from the Children's Oncology Group

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.10013 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 10013-10013

Author(s):

S. G. DuBois ◽

M. D. Krailo ◽

E. F. Cook ◽

N. J. Tarbell ◽

C. J. Fryer ◽

...

Keyword(s):

Disease Progression ◽

Local Control ◽

Ewing Sarcoma ◽

Tumor Size ◽

Cumulative Incidence ◽

Hazard Ratio ◽

Local Failure ◽

Control Mode ◽

Distant Failure ◽

Risk Of Disease

10013 Background: Options for local control in patients (pts) with Ewing sarcoma (EWS) include surgery (S), radiation (R), or surgery plus radiation (S+R). The choice of local control depends on factors that also impact outcome in EWS, including tumor site, tumor size, and age. Our objective was to determine if risk of disease progression differs between local control methods, after controlling for potential confounders. Methods: We analyzed the cohort of pts with non-metastatic EWS of the bone treated on Intergroup Study-0091 (Grier et al, NEJM, 2003). Local control decisions were made on an individual basis. We excluded pts with tumors of the skull/face, progression prior to end of local control, or incomplete local control data. Disease progression was recorded from end of local control. Cumulative incidence of disease progression was determined using a competing risks approach. We constructed a Cox proportional hazards model of progression free survival incorporating local control mode and potential confounders into the model. Secondary analyses evaluated overall survival, local failure, and distant failure. Results: 329 pts met eligibility criteria for analysis. 122 pts received S, 142 received R, and 65 received S+R. The cumulative incidence of disease progression at 5 years was 22.1% (95% CI 15.1–29.9%) for S, 36.9% (29.0–44.9%) for R, and 48.1% (35.5- 59.7%) for S+R. Using R as the reference group and controlling for age, tumor size, tumor location, and chemotherapy regimen, the hazard ratio for progression was 0.66 (95% CI 0.38–1.13) for S and 1.55 (0.96–2.49) for S+R. The hazard ratio for death was 0.77 (95% CI 0.44–1.34) for S and 1.46 (0.88–2.42) for S+R. The hazard ratio for local failure was 0.38 (95% CI 0.15–0.98; p=0.04) for S and 0.77 (0.34–1.75) for S+R. The hazard ratio for distant failure was 0.78 (0.42–1.46) for S and 1.60 (0.91–2.82) for S+R. Conclusions: Observed differences in outcome between local control groups are largely due to confounding factors that affect outcome and local control choice. Risk of disease progression, distant failure, or death does not differ between pts who receive S or R. Pts who receive S have a decreased risk of local failure compared to pts who receive R. No significant financial relationships to disclose.

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Local Control in Pelvic Ewing Sarcoma: Analysis From INT-0091—A Report From the Children's Oncology Group

Journal of Clinical Oncology ◽

10.1200/jco.2006.05.9188 ◽

2006 ◽

Vol 24 (24) ◽

pp. 3838-3843 ◽

Cited By ~ 92

Author(s):

Torunn I. Yock ◽

Mark Krailo ◽

Christopher J. Fryer ◽

Sarah S. Donaldson ◽

James S. Miser ◽

...

Keyword(s):

Local Control ◽

Ewing Sarcoma ◽

Local Failure ◽

Distant Failure ◽

Pelvic Tumors ◽

Significant Difference ◽

Study Population ◽

The Impact ◽

To Receive

Purpose The impact of the modality used for local control of Ewing sarcoma is uncertain. We investigated the relationship between the type of local control modality, surgery, radiation (RT) or both (S + RT), and subsequent risk for local failure (LF) in patients with nonmetastatic pelvic Ewing sarcoma treated on INT-0091. Patients and Methods Patients ≤ 30 years with Ewing sarcoma, primitive neuroectodermal tumor or primitive sarcoma of bone were randomly assigned to receive chemotherapy with doxorubicin, vincristine, cyclophosphamide, and dactinomycin, (VACA) or with these four drugs alternating with ifosfamide and etoposide (VACA-IE). The local control modality, surgery, RT or both was chosen by the treating physicians. The effect of local control modality was assessed after adjusting for the size of tumor (< 8 cm, ≥ 8 cm) and chemotherapy type. Results Seventy-five patients with pelvic tumors and a median follow-up of 4.4 years (0.6 to 11.4 years) comprised the study population. Twelve underwent surgery, 44 received RT, and 19 received both. The 5-year event-free survival (EFS) and cumulative incidence of LF was 49% and 21% (16%, LF only; 5%, LF and distant failure). There was no significant difference in EFS or LF by tumor size (< 8 cm, ≥ 8 cm), local control (LC) modality, or chemotherapy. However, VACA-IE seems to confer an LC benefit (11% v 30%; P = .06). Conclusion There was no significant effect of local control modality (surgery, RT or S + RT) selected by the treating physicians on rates of local failure or EFS. However, VACA-IE improves LC (11%) compared with previously published results for pelvic Ewing sarcoma.

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Radiosurgery Followed by Planned Observation in Patients with One to Three Brain Metastases

Neurosurgery ◽

10.1093/neurosurgery/52.5.1066 ◽

2003 ◽

Vol 52 (5) ◽

pp. 1066-1074 ◽

Cited By ~ 1

Author(s):

Johannes Lutterbach ◽

Donatus Cyron ◽

Karl Henne ◽

Christoph B. Ostertag

Keyword(s):

Risk Factors ◽

Brain Metastasis ◽

Brain Metastases ◽

Local Control ◽

Cox Model ◽

Recursive Partitioning ◽

Radiation Therapy Oncology Group ◽

Recursive Partitioning Analysis ◽

Maximum Diameter ◽

Single Brain Metastasis

Abstract OBJECTIVE To analyze the role of radiosurgery alone in patients with brain metastases. There were three specific study goals: 1) to determine whether survival of patients selected for this treatment approach can be predicted successfully by use of the recursive partitioning analysis classification defined by the Radiation Therapy Oncology Group; 2) to evaluate local control; and 3) to identify risk factors of cerebral failure. METHODS A total of 101 patients with Karnofsky Performance Scale scores of at least 50 and up to three brain metastases, each 3 cm or less in maximum diameter, were treated with radiosurgery alone. Survival, local control, distant brain freedom from progression (FFP), and overall brain FFP were evaluated according the method of Kaplan and Meier. Risk factors for survival and overall brain FFP were analyzed using the Cox model. RESULTS Median survival was 13.4 months, 9.3 months, and 1.5 months for patients in recursive partitioning analysis Classes 1, 2, and 3, respectively (P< 0.0001). At 1 year, local control, distant brain FFP, and overall brain FFP were 91, 53, and 51%, respectively. An interval greater than 2 years between diagnosis of the primary tumor and diagnosis of brain metastases and the presence of a single brain metastasis were associated with significantly higher overall brain FFP. CONCLUSION Recursive partitioning analysis classification successfully predicted survival. Radiosurgery alone yielded high local control. Overall brain FFP was highest in patients with an interval greater than 2 years between primary diagnosis and diagnosis of a single brain metastasis.

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Gamma Knife radiosurgery for brain metastasis: review of 103 patients

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0038-1625571 ◽

2009 ◽

Vol 28 (04) ◽

pp. 133-138

Author(s):

Marcos Antônio Dellaretti Filho ◽

George de Albuquerque Cavalcanti Mendes ◽

Nicolas Reyns ◽

Gustavo Touzet ◽

François Dubois ◽

...

Keyword(s):

Overall Survival ◽

Brain Metastasis ◽

Gamma Knife ◽

Local Control ◽

Tumor Volume ◽

Karnofsky Performance Status ◽

Performance Status ◽

Gamma Knife Radiosurgery ◽

Intracranial Metastasis ◽

Free Survival

Abstract Objective: To assess clinical and imaging outcomes in patients treated with Gamma Knife stereotactic radiosurgery (SRS) for brain metastasis. Methods: One hundred and three patients with 158 intracranial metastasis consecutively underwent Gamma Knife SRS between January, 2004 and December, 2006. The results were based on last imaging and the date of the last visit. Average age of the patients was 56 years (range 32-84 years). Karnofsky performance status average was 87.6. Fifty-eight (56.3%) patients had single brain metastasis. The average tumor volume was 2.5cc (range 0.02-16.6 cc). The SRS marginal dose average was 23.4 Gy (range 15-25 Gy). Results: Treatment sequence was SRS alone (89 patients) or SRS plus whole-brain radiotherapy (WBRT) (14 patients). The 1-year local control was 80%, being better for tumors with volume <5cc than for ≥5 cc: 86% vs 53% (p<0.05). The 1-year distant brain metastasis-free survival incidence was 73%. The initial number of brain lesions (single vs multiple) was not a significant factor on distant brain metastasis: free survival at 1 year was 75% for single metastases and 70% for multiple lesions. Renal cancer was the only factor with a significant effect on distant brain metastasis. The median overall survival was 15 months. According to unifactorial and multifactorial analysis, three prognostic factors for overall survival were retrieved recursive partitioning analysis (RPA) class, Karnofsky index performance and tumor volume. Conclusion: In this series, SRS provided excellent local control with relatively low morbidity in patients with brain metastases.

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Carcinoma of the ampulla of Vater: Patterns of failure after resection and benefit of adjuvant radiotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.254 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 254-254

Author(s):

M. Palta ◽

C. G. Willett ◽

P. Patel ◽

D. S. Tyler ◽

H. E. Uronis ◽

...

Keyword(s):

Radiation Therapy ◽

Local Control ◽

Survival Rates ◽

Radical Resection ◽

Ampulla Of Vater ◽

Ampullary Carcinoma ◽

Local Failure ◽

Term Survival ◽

Free Survival ◽

Significant Difference

254 Background: Ampullary carcinoma is a rare malignancy. Despite radical resection, survival rates remain low with high rates of local failure. To define the role of radiation therapy and chemotherapy with surgery, we performed a single institution analysis of treatment- related outcomes. Methods: A retrospective analysis was performed of all patients undergoing potentially curative therapy for adenocarcinoma of the ampulla of Vater at Duke University Hospitals between 1975 and 2009. Local control (LC), overall survival (OS), disease-free survival (DFS), and metastases-free survival (MFS) were estimated using the Kaplan-Meier Method. Results: One hundred thirty-seven patients with ampullary carcinoma underwent potentially curative pancreaticoduodenectomy. Sixty-one patients undergoing resection received adjuvant (n= 43) or neoadjuvant (n=18) radiation therapy with concurrent chemotherapy (CRT). Patients receiving radiotherapy were more likely to have poorly differentiated tumors. Median radiation dose was 50 Gy. Median follow up was 8.8 years. Of patients receiving neoadjuvant therapy, 67% were downstaged on final pathology with 28% achieving pathologic complete response. Three-year local control was significantly improved in patients receiving CRT (88% vs. 55% p= 0.001) with trend toward a 3-year OS benefit in patients receiving CRT (62% vs. 46% p=0.074). Despite this, there was no significant difference in 3-year DFS (66% CRT vs 48% surgery alone p=0.09) or MFS (69% CRT vs 63% surgery alone p=0.337). Conclusions: Long term survival rates are low. Local failure rates are high following radical resection alone and improved with CRT. Despite more adverse pathologic features in patients receiving CRT, survival outcomes were at least equivalent with a trend toward statistical significance. Given the patterns of relapse with surgery alone and local control benefit in patients receiving CRT, the use of chemoradiotherapy in selected patients should be considered. No significant financial relationships to disclose.

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Definitive Chemoradiotherapy in Elderly Cervical Cancer Patients: A Multiinstitutional Analysis

International Journal of Gynecological Cancer ◽

10.1097/igc.0000000000001029 ◽

2017 ◽

Vol 27 (7) ◽

pp. 1446-1454 ◽

Cited By ~ 4

Author(s):

Ozan Cem Guler ◽

Sezin Yuce Sari ◽

Sumerya Duru Birgi ◽

Melis Gultekin ◽

Ferah Yildiz ◽

...

Keyword(s):

Cervical Cancer ◽

Prognostic Factors ◽

Local Recurrence ◽

Cancer Patients ◽

Local Control ◽

External Beam Radiation ◽

Significant Prognostic Factor ◽

Definitive Chemoradiotherapy ◽

Beam Radiation ◽

Significant Difference

ObjectiveThe aim of the study was to investigate the prognostic factors for survival and treatment-related toxicities in older (≥65 years) cervical cancer patients treated with definitive chemoradiotherapy. In addition, we sought to compare the outcomes between the older elderly (≥75 years) and their younger old counterparts (age, 65–74 years).Materials and MethodsWe retrospectively reviewed medical records from 269 biopsy-proven nonmetastatic cervical cancer patients treated with external radiotherapy and intracavitary brachytherapy at the departments of radiation oncology in 2 different universities. The prognostic factors for survival, local control, and distant metastasis (DM) were analyzed.ResultsThe median follow-up time was 38.8 months (range, 1.5–175.5 months) for the entire cohort and 70.0 months (range, 6.1–175.7 months) for survivors. The 2- and 5-year overall survival (OS), disease-free survival (DFS), and cause-specific survival rates were 66% and 42%, 63% and 39%, and 72% and 55%, respectively. Patients 75 years or older showed significantly worse OS compared with patients aged 65 to 74 years but showed no significant difference in DFS. The 2- and 5-year local control rates were 86% and 71%, respectively. The incidences of DMs at 2 and 5 years were 22% and 30%, respectively. In multivariate analysis, vaginal infiltration and lymph node metastasis were predictive of OS, DFS, local recurrence, and DM. Concomitant chemotherapy was predictive of OS, DFS, and local recurrence, and larger tumor (>4 cm) was a significant prognostic factor for local recurrence. None of the patients had toxicity that necessitated the discontinuation of radiotherapy. All patients were evaluable for acute toxicity, and no grade higher than 3 adverse events occurred during external beam radiation therapy or brachytherapy.ConclusionsAlthough age limited the delivery of aggressive treatment, concurrent chemoradiotherapy in elderly patients associated with improved outcomes similar as in younger counterparts without increasing serious acute and late toxicities.

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Comparison of Definitive Cervical Cancer Management With Chemotherapy and Radiation Between Two Centers With Variable Resources and Opportunities for Improved Treatment

JCO Global Oncology ◽

10.1200/go.20.00303 ◽

2020 ◽

pp. 1510-1518

Author(s):

Francis Adumata Asamoah ◽

Joel Yarney ◽

Aba Scott ◽

Verna Vanderpuye ◽

Zhigang Yuan ◽

...

Keyword(s):

Cervical Cancer ◽

Local Control ◽

Treatment Duration ◽

Multivariable Analysis ◽

Stage Iii ◽

High Dose ◽

Early Stage Disease ◽

Cancer Management ◽

Comparative Review ◽

Significant Difference

PURPOSE Cervical cancer remains a major health challenge in low- to middle-income countries. We present the experiences of two centers practicing in variable resource environments to determine predictors of improved radiochemotherapy treatment. METHODS AND MATERIALS This comparative review describes cervical cancer presentation and treatment with concurrent chemoradiotherapy with high-dose-rate brachytherapy between 2014 and 2017 at the National Radiotherapy Oncology and Nuclear Medicine Center (NRONMC) in Korle-Bu Teaching Hospital, Accra, Ghana, and Moffitt Cancer Center (MCC), Tampa, FL. RESULTS Median follow-up for this study was 16.9 months. NRONMC patients presented with predominantly stage III disease (42% v 16%; P = .002). MCC patients received para-aortic node irradiation (16%) and interstitial brachytherapy implants (19%). Median treatment duration was longer for NRONMC patients compared with MCC patients (59 v 52 days; P < .0001), and treatment duration ≥ 55 days predicted worse survival on multivariable analysis (MVA; P = .02). Stage ≥ III disease predicted poorer local control on MVA. There was a difference in local control among patients with stage III disease (58% v 91%; P = .03) but not in survival between MCC and NRONMC. No significant difference in local control was observed for stage IB, IIA, and IIB disease. CONCLUSION Although there were significant differences in disease presentation between the two centers, treatment outcomes were similar for patients with early-stage disease. Longer treatment duration and stage ≥ III disease predicted poor outcomes.

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INNV-03. EFFICACY AND LONG-TERM OUTCOMES IN THE MANAGEMENT OF LARGE BRAIN METASTASIS (≥ 4 CM3) USING 2-STAGED STEREOTACTIC RADIOSURGERY (2-SSRS): AN INTERNATIONAL STUDY

Neuro-Oncology ◽

10.1093/neuonc/noaa215.487 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii117-ii117

Author(s):

Yusuke Hori ◽

Shoji Yomo ◽

Wei Wei ◽

Josue Avecillas-Chasin ◽

Gene Barnett ◽

...

Keyword(s):

Brain Metastases ◽

Stereotactic Radiosurgery ◽

Cox Regression ◽

Multivariable Analysis ◽

International Study ◽

Target Volume ◽

Local Failure ◽

Maximum Diameter ◽

Large Brain

Abstract INTRODUCTION Stereotactic radiosurgery (SRS) for brain metastases results in time-to-local failure (TTLF) that significantly correlates with target volume and prescription dose. For large brain metastases (LBM), defined as ≥ 4 cm3, SRS monotherapy can result in < 40% local control (LC) rates. To overcome the TTLF limitations in the management of LBM, 2-staged SRS (2-SSRS) has demonstrated 6-month LC rates of 85–90%. This international multi-institutional study represents the largest series of patients with LBM managed with 2-SSRS. METHODS 181 patients with 218 LBM treated with 2-SSRS were retrospectively reviewed. Local failure (LF) was defined as ≥ 71.5% volumetric increase (equivalent to ≥ 20% increase in maximum diameter; RECIST criteria) from smallest volume date. Kaplan-Meier and log-rank tests were used to estimate and compare overall survival (OS) and TTLF; multivariable analysis was performed using Cox regression model. RESULTS Median age was 63 years (range: 29‒88), male sex was 50.3% with 34.8% of patients having non-small cell lung cancer. Median follow-up was 13.8 months (range:1.1‒49.4) and median OS was 14.6 months (95%CI: 12.6‒17.0). Median TTLF was 27.9 months (95%CI: 17.9‒NA) with a cumulative 6, 12 and 24-month LC of 91%, 81% and 71%, respectively. Using multivariable analysis, older age (≥ 65 years old; HR 1.58, 95%CI 1.06‒2.35, p=0.02) and larger total volume of concurrent small lesions (> 3 cm3; HR 2.05, 95%CI 1.25‒3.39, p=0.005) negatively impacted OS while younger age (< 65 years old; HR 2.60, 95%CI 1.26‒5.34, p=0.01) and RPA Class 3 (HR 3.10, 95%CI 1.26‒7.65, p=0.01) decreased TTLF. The number of concurrent LBM treated and total volume of the LBM were not significant factors. CONCLUSIONS This large multi-institutional dataset demonstrates excellent efficacy and long-term control of LBMs treated with 2-SSRS, which is independent of number or total volume of concurrent LBM.

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