Stereotactic radiosurgery for brain metastases: a case-matched study comparing treatment results for patients 80 years of age or older versus patients 65–79 years of age

2014 ◽  
Vol 121 (5) ◽  
pp. 1148-1157 ◽  
Author(s):  
Shinya Watanabe ◽  
Masaaki Yamamoto ◽  
Yasunori Sato ◽  
Takuya Kawabe ◽  
Yoshinori Higuchi ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Statistical Significance ◽  
Disease Status ◽  
Competing Risk ◽  
Treatment Results ◽  
Number Of Patients ◽  
Group A ◽  
Group B ◽  
Matched Study

Object Recently, an increasing number of patients with brain metastases, even patients over 80 years of age, have been treated with stereotactic radiosurgery (SRS). However, there is little information on SRS treatment results for patients with brain metastases 80 years of age and older. The authors undertook this study to reappraise whether SRS treatment results for patients 80 years of age or older differ from those of patients who are 65–79 years old. Methods This was an institutional review board–approved, retrospective cohort study. Among 2552 consecutive brain metastasis patients who underwent SRS during the 1998–2011 period, we studied 165 who were 80 years of age or older (Group A) and 1181 who were age 65–79 years old (Group B). Because of the remarkable disproportion in patient numbers between the 2 groups and considerable differences in pre-SRS clinical factors, the authors conducted a case-matched study using the propensity score matching method. Ultimately, 330 patients (165 from each group, A and B) were selected. For time-to-event outcomes, the Kaplan-Meier method was used to estimate overall survival and competing risk analysis was used to estimate other study end points, as appropriate. Results Although the case-matched study showed that post-SRS median survival time (MST, months) was shorter in Group A patients (5.3 months, 95% CI 3.9–7.0 months) than in Group B patients (6.9 months, 95% CI 5.0–8.1 months), this difference was not statistically significant (HR 1.147, 95% CI 0.921–1.429, p = 0.22). Incidences of neurological death and deterioration were slightly lower in Group A than in Group B patients (6.3% vs 11.8% and 8.5% vs 13.9%), but these differences did not reach statistical significance (p = 0.11 and p = 0.16). Furthermore, competing risk analyses showed that the 2 groups did not differ significantly in cumulative incidence of local recurrence (HR 0.830, 95% CI 0.268–2.573, p = 0.75), rates of repeat SRS (HR 0.738, 95% CI 0.438–1.242, p = 0.25), or incidence of SRS-related complications (HR 0.616, 95% CI 0.152–2.495, p = 0.49). Among the Group A patients, post-SRS MSTs were 11.6 months (95% CI 7.8–19.6 months), 7.9 months (95% CI 5.2–10.9 months), and 2.8 months (95% CI; 2.4–4.6 months) in patients whose disease status was modified–recursive partitioning analysis (RPA) Class(es) I+IIa, IIb, and IIc+III, respectively (p < 0.001). Conclusions Our results suggest that patients 80 years of age or older are not unfavorable candidates for SRS as compared with those 65–79 years old. Particularly, even among patients 80 years and older, those with modified-RPA Class I+IIa or IIb disease are considered to be favorable candidates for more aggressive treatment of brain metastases.

scholarly journals A case-matched study of stereotactic radiosurgery for patients with multiple brain metastases: comparing treatment results for 1–4 vs ≥ 5 tumors

2013 ◽  
Vol 118 (6) ◽  
pp. 1258-1268 ◽  
Author(s):  
Masaaki Yamamoto ◽  
Takuya Kawabe ◽  
Yasunori Sato ◽  
Yoshinori Higuchi ◽  
Tadashi Nariai ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Brain Metastases ◽  
Survival Time ◽  
Stereotactic Radiosurgery ◽  
Median Survival ◽  
Median Survival Time ◽  
Free Survival ◽  
Group A ◽  
Group B ◽  
Matched Study

Object Although stereotactic radiosurgery (SRS) alone for patients with 4–5 or more tumors is not a standard treatment, a trend for patients with 5 or more tumors to undergo SRS alone is already apparent. The authors' aim in the present study was to reappraise whether SRS results for ≥ 5 tumors differ from those for 1–4 tumors. Methods This institutional review board–approved retrospective cohort study used the authors' database of prospectively accumulated data that included 2553 consecutive patients who underwent SRS, not in combination with concurrent whole-brain radiotherapy, for brain metastases (METs) between 1998 and 2011. These 2553 patients were divided into 2 groups: 1553 with tumor numbers of 1–4 (Group A) and 1000 with ≥ 5 tumors (Group B). Because there was considerable bias in pre-SRS clinical factors between Groups A and B, a case-matched study was conducted. Ultimately, 1096 patients (548 each in Groups A and B) were selected. The standard Kaplan-Meier method was used to determine post-SRS survival and the post-SRS neurological death–free survival times. Competing risk analysis was applied to estimate cumulative incidences of local recurrence, repeat SRS for new lesions, neurological deterioration, and SRS-induced complications. Results The post-SRS median survival time was significantly longer in the 548 Group A patients (7.9 months, 95% CI 7.0–8.9 months) than in the 548 Group B patients (7.0 months 95% [CI 6.2–7.8 months], HR 1.176 [95% CI 1.039–1.331], p = 0.01). However, incidences of neurological death were very similar: 10.6% in Group A and 8.2% in Group B (p = 0.21). There was no significant difference between the groups in neurological death–free survival intervals (HR 0.945, 95% CI 0.636–1.394, p = 0.77). Furthermore, competing risk analyses showed that there were no significant differences between the groups in cumulative incidences of local recurrence (HR 0.577, 95% CI 0.312–1.069, p = 0.08), repeat SRS (HR 1.133, 95% CI 0.910–1.409, p = 0.26), neurological deterioration (HR 1.868, 95% CI 0.608–1.240, p = 0.44), and major SRS-related complications (HR 1.105, 95% CI 0.490–2.496, p = 0.81). In the authors' cohort, age ≤ 65 years, female sex, a Karnofsky Performance Scale score ≥ 80%, cumulative tumor volume ≤ 10 cm3, controlled primary cancer, no extracerebral METs, and neurologically asymptomatic status were significant factors favoring longer survival equally in both groups. Conclusions This retrospective study suggests that increased tumor number is an unfavorable factor for longer survival. However, the post-SRS median survival time difference, 0.9 months, between the two groups is not clinically meaningful. Furthermore, patients with 5 or more METs have noninferior results compared to patients with 1–4 tumors, in terms of neurological death, local recurrence, repeat SRS, maintenance of good neurological state, and SRS-related complications. A randomized controlled trial should be conducted to test this hypothesis.

Role of intraoperative neuromonitoring of the recurrent laryngeal nerves during thyroid reoperations of recurrent goiter

2017 ◽  
Vol 89 (3) ◽  
pp. 11-15 ◽  
Author(s):  
Jan Sopiński ◽  
Krzysztof Kuzdak ◽  
Masoud Hedayati ◽  
Krzysztof Kołomecki
Keyword(s):  
At Risk ◽  
Statistical Significance ◽  
Operation Time ◽  
Intraoperative Neuromonitoring ◽  
Number Of Patients ◽  
Recurrent Goiter ◽  
Group A ◽  
Procedure Duration ◽  
Recurrent Laryngeal Nerves ◽  
Group B

Reoperations of the thyroid gland are challenging to any surgeon. Such procedures are technically difficult and involve higher risk of complications than primary procedures. Recurrent laryngeal nerve (RLN) palsy is one of such complications The aim of the study was to evaluate the effectiveness of intraoperative neuromonitoring (IONM) in preventing RLN palsy during recurrent goiter operations. Material and methods. We retrospectively analyzed the results of thyroid reoperation performed at the Department of Endocrine, General and Vascular Surgery of Medical University of Lodz in the period from January 2014 to June 2016. The study included 80 patients, who were divided into 2 groups: group A consisted of 27 patients, who had undergone surgery with the use of IONM, while group B included 53 patients, in whom RLN was identified visually. During statistical analysis we took into account the number of nerves at risk, not the number of patients. There were 47 nerves at risk In group A and 86 in group B. We analyzed whether application of IONM had any effect on the frequency of RLN palsy and procedure duration. Results. The frequency of RLN palsy was 10.64% (5/47) in group A and 15.12% (13/86) in group B (no statistical significance, p=0,47). Mean operation time was shorter in group B 71.29 ± 17.125 minutes vs. 75.75 ± 17.94 minutes in group A (no statistical significance, p=0,377). Conclusion. Use of IONM did not significantly reduce the occurrence of RLN palsy and procedure duration.

scholarly journals 1379. Comparison of Inpatient Tuberculosis Screening Methods and Their Effect on Patient Duration in Airborne Isolation

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S501-S501
Author(s):  
Mary Katherine. Theoktisto ◽  
Delvina Ford ◽  
Omar Khan ◽  
Kelly R Reveles ◽  
Jose Cadena
Keyword(s):  
Statistical Significance ◽  
Nucleic Acid Amplification ◽  
Health Concern ◽  
Smear Microscopy ◽  
Screening Methods ◽  
Number Of Patients ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Crude Analysis

Abstract Background Tuberculosis (TB) remains a significant public health concern, and exposure in healthcare settings is prevalent. Current guidelines recommend testing for TB by acid-fast bacilli (AFB) smear microscopy with 3 sputum samples and/or using nucleic acid amplification test (NAAT), and mycobacterium culture. The purpose of this project is to compare how different TB diagnostic tests affect the duration of stay in respiratory isolation. Methods This study was conducted at the Veteran Affairs South Texas hospital, which includes a total of 437 beds. Data were collected retrospectively from medical records. Eligibility included patients admitted to the hospital and placed in airborne isolation for TB screening and diagnosis, had 3 sputum samples collected 8 hours apart and/or had 2 PCR MTB/RIF. Patients were excluded if they had TB or were not undergoing evaluation for TB. Three time periods analyzed included, 3 AFB sputum samples analyzed in-house from December 2012 to January 2014 (Group A), 3 AFB sputum samples analyzed at outside facility during 2013 to 2014 as well as 2 months in 2012 (Group B), and 2 MTB PCR/RIF in house during 2017 and 2018 (Group C). Duration of isolation was compared between groups using the Kruskal–Wallis test. A total number of 815 patients were screened, leaving 105 patients for analysis after exclusion. There were 49 patients analyzed from Group A, 28 from Group B, and 28 from Group C. Results Crude analysis of the data showed numerical differences in the total number of days and hours in isolation between the 3 groups. The average (mean) days in isolation were 4.2 for Group A, 7.4 for Group B, and 5.5 for Group C. There was no statistically significant difference in either days or hours of airborne precautions by “rule out” method. Days of isolation in airborne precautions (median IQR) was 4 for all groups (P = 0.3313). Likewise, hours of airborne precautions had a median IQR of 96 for all groups P = 0.4347. Conclusion Although there was no statistical significance between the groups, crude analysis did show a numerical difference in the mean total airborne days and hours. Lack of statistical difference may be due to low number of patients, timing of order placement for in-house PCR, and longer than expected stay in airborne precautions. Disclosures All authors: No reported disclosures.

The effect of timing of stereotactic radiosurgery treatment of melanoma brain metastases treated with ipilimumab

2017 ◽  
Vol 127 (5) ◽  
pp. 1007-1014 ◽  
Author(s):  
Or Cohen-Inbar ◽  
Han-Hsun Shih ◽  
Zhiyuan Xu ◽  
David Schlesinger ◽  
Jason P. Sheehan
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Stage Iv ◽  
Analysis Data ◽  
Perilesional Edema ◽  
Therapeutic Benefits ◽  
Clinical Responses ◽  
Group A ◽  
Group B ◽  
The University

OBJECTIVEMelanoma represents the third most common cause of CNS metastases. Immunotherapy has evolved as a treatment option for patients with Stage IV melanoma. Stereotactic radiosurgery (SRS) also elicits an immune response within the brain and may interact with immunotherapy. The authors report on a cohort of patients treated for brain metastases with immunotherapy and evaluate the effect of SRS timing on the intracranial response.METHODSAll consecutively treated melanoma patients receiving ipilimumab and SRS for treatment of brain metastases at the University of Virginia between 2009 and 2014 were included in this retrospective analysis; data from 46 patients harboring 232 brain metastases were reviewed. The median duration of clinical follow-up was 7.9 months (range 3–42.6 months). The median age of the patients was 63 years (range 24.3–83.6 years). Thirty-two patients received SRS before or during ipilimumab cycles (Group A), whereas 14 patients received SRS after ipilimumab treatment (Group B). Radiographic and clinical responses were assessed at approximately 3-month intervals after SRS.RESULTSThe 2 cohorts were comparable in pertinent baseline characteristics with the exception of SRS timing relative to ipilimumab. Local recurrence–free duration (LRFD) was significantly longer in Group A (median 19.6 months, range 1.1–34.7 months) than in Group B patients (median 3 months, range 0.4–20.4 months) (p = 0.002). Post-SRS perilesional edema was more significant in Group A.CONCLUSIONSThe effect of SRS and ipilimumab on LRFD seems greater when SRS is performed before or during ipilimumab treatments. The timing of immunotherapy and SRS may affect LRFD and postradiosurgical edema. The interactions between immunotherapy and SRS warrant further investigation so as to optimize the therapeutic benefits and mitigate the risks associated with multimodality, targeted therapy.

The Effect of Forewarning on the Occurrence of Side-Effects and Discontinuance of Medication in Patients on Dothiepin

1976 ◽  
Vol 4 (4) ◽  
pp. 237-240 ◽  
Author(s):  
E D Myers ◽  
E J Calvert
Keyword(s):  
Side Effects ◽  
Statistical Significance ◽  
Final Analysis ◽  
Number Of Patients ◽  
Group A ◽  
Group B ◽  
Patients Experience ◽  
Larger Sample

Dothiepin was prescribed for 100 depressed out-patients alternately allocated to one of two groups. Patients in Group A were forewarned about side-effects and patients in Group B were not forewarned. None of the patients had previously received dothiepin. After two weeks the patients were questioned regarding side-effects and continuance with medication. Eighty-nine patients were included in the final analysis. The results failed to confirm the hypotheses that forewarning patients of side-effects causes a greater number of patients to complain of such effects, or that where patients experience side-effects, forewarning is associated with any less frequent discontinuance of therapy. Compared with a previous study with amitriptyline, the results of this study are much closer to statistical significance. This may be due to the lower overall incidence of side-effects with dothiepin and calls for further work with a larger sample of patients.

scholarly journals PS1 - 140 The Effect of Timing of Stereotactic Radiosurgery Treatment of Melanoma Brain Metastases Treated with Ipilimumab

2016 ◽  
Vol 43 (S4) ◽  
pp. S6-S7 ◽  
Author(s):  
O. Cohen-Inbar
Keyword(s):  
Brain Metastasis ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Stage Iv ◽  
Perilesional Edema ◽  
Therapeutic Benefits ◽  
Clinical Responses ◽  
Group A ◽  
Pre Treatment ◽  
Group B

Melanoma represents the third most common cause of CNS metastases. Immunotherapy has evolved as a treatment option for patients with stage-IV melanoma. Stereotactic radiosurgery (SRS) also elicits an immune response within the brain and may interact with immunotherapy. We report a cohort of patients treated for brain metastasis with immunotherapy and evaluate the effect of SRS timing on the intracranial response. Methods: All consecutively treated melanoma patients receiving Ipilimumab and SRS for their brain metastasis were included in the retrospective analysis. 46 patients harboring 232 brain metastases were reviewed. The median clinical follow-up was 7.9 months (3-42.6). Median age was 63 years (24.3-83.6). 32 patients received SRS before or during ipilimumab cycles (Group-A) whereas 14 patients received SRS after the ipilimumab treatment (Group-B). Radiographic and clinical responses were assessed at approximately 3 months intervals after SRS. Results: The two cohorts were comparable in pertinent pre-treatment aspects with the exception of SRS timing relative to ipilimumab. Local recurrence free duration (LRFD) was significantly longer in Group-A patients (19.6 months, range 1.1-34.7 months) as compared to group-B patients (3 months, range 0.4-20.4 months), respectively (p=0.002). Post-SRS perilesional edema was more significant in Group-A. Conclusions: The effect of SRS and ipilimumab in attaining LRFD seems greater when SRS is performed before or during ipilimumab treatments. The timing of immunotherapy and SRS may effect LRFD and post-radiosurgical edema. The interactions between immunotherapy and SRS warrant further investigation so as to optimize the therapeutic benefits and mitigate the risks associated with multimodality, targeted therapy.

scholarly journals Stereotactic radiosurgery for patients with multiple brain metastases: a case-matched study comparing treatment results for patients with 2–9 versus 10 or more tumors

2014 ◽  
Vol 121 (Suppl_2) ◽  
pp. 16-25 ◽  
Author(s):  
Masaaki Yamamoto ◽  
Takuya Kawabe ◽  
Yasunori Sato ◽  
Yoshinori Higuchi ◽  
Tadashi Nariai ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Cumulative Incidence ◽  
Neurological Deterioration ◽  
Clinical Factors ◽  
Survival Times ◽  
Treatment Results ◽  
Free Survival ◽  
Group A ◽  
Group B ◽  
Matched Study

ObjectAlthough stereotactic radiosurgery (SRS) alone is not a standard treatment for patients with 4–5 tumors or more, a recent trend has been for patients with 5 or more, or even 10 or more, tumors to undergo SRS alone. The aim of this study was to reappraise whether the treatment results for SRS alone for patients with 10 or more tumors differ from those for patients with 2–9 tumors.MethodsThis was an institutional review board–approved, retrospective cohort study that gathered data from the Katsuta Hospital Mito GammaHouse prospectively accumulated database. Data were collected for 2553 patients who consecutively had undergone Gamma Knife SRS alone, without whole-brain radiotherapy (WBRT), for newly diagnosed (mostly) or recurrent (uncommonly) brain metastases during 1998–2011. Of these 2553 patients, 739 (28.9%) with a single tumor were excluded, leaving 1814 with multiple metastases in the study. These 1814 patients were divided into 2 groups: those with 2–9 tumors (Group A, 1254 patients) and those with 10 or more tumors (Group B, 560 patients). Because of considerable bias in pre-SRS clinical factors between groups A and B, a case-matched study, which used the propensity score matching method, was conducted for clinical factors (i.e., age, sex, primary tumor state, extracerebral metastases, Karnofsky Performance Status, neurological symptoms, prior procedures [surgery and WBRT], volume of the largest tumor, and peripheral doses). Ultimately, 720 patients (360 in each group) were selected. The standard Kaplan-Meier method was used to determine post-SRS survival times and post-SRS neurological death–free survival times. Competing risk analysis was applied to estimate cumulative incidence for local recurrence, repeat SRS for new lesions, neurological deterioration, and SRS-induced complications.ResultsPost-SRS median survival times did not differ significantly between the 2 groups (6.8 months for Group A vs 6.0 months for Group B; hazard ratio [HR] 1.133, 95% CI 0.974–1.319, p = 0.10). Furthermore, rates of neurological death were very similar: 10.0% for group A and 9.4% for group B (p = 0.89); neurological death–free survival times did not differ significantly between the 2 groups (HR 1.073, 95% CI 0.649–1.771, p = 0.78). The cumulative incidence of local recurrence (HR 0.425, 95% CI 0.0.181–0.990, p = 0.04) and repeat SRS for new lesions (HR 0.732, 95% CI 0.554–0.870, p = 0.03) were significantly lower for Group B than for Group A patients. No significant differences between the groups were found for cumulative incidence for neurological deterioration (HR 0.994, 95% CI 0.607–1.469, p = 0.80) or SRS-related complications (HR 0.541, 95% CI 0.138–2.112, p = 0.38).ConclusionsPost-SRS treatment results (i.e., median survival time; neurological death–free survival times; and cumulative incidence for local recurrence, repeat SRS for new lesions, neurological deterioration, and SRS-related complications) were not inferior (neither less effective nor less safe) for patients in Group B than for those in Group A. We conclude that carefully selected patients with 10 or more tumors are not unfavorable candidates for SRS alone. A randomized controlled trial should be conducted to test this hypothesis.

scholarly journals Determining Relation between Gallstone and Lipid Profile

2018 ◽  
Vol 3 (2) ◽  
pp. 418-422 ◽  
Author(s):  
Rabin Raj Singh ◽  
Sunil Chandra Adhikari ◽  
Ravi Bastakoti ◽  
Sunil Regmi ◽  
Ravindra Baskota ◽  
...  
Keyword(s):  
Lipid Profile ◽  
Serum Cholesterol ◽  
Statistical Significance ◽  
Serum Triglyceride ◽  
P Value ◽  
Number Of Patients ◽  
Increased Risk ◽  
Group A ◽  
Group B ◽  
Low Serum

Introduction: Cholelithiasis is presence of stone in gallbladder. Female sex, obesity, pregnancy, fatty foods, all are associated with an increased risk of developing gallstones. There is paucity of information regarding relation of cholelithiasis and lipid profile. In this study the association of serum lipids to cholelithiasis has been tried to been elucidated.Objectives: The general objective was to determine the relation of Serum lipid in cholelithiasis. The specific objectives were to compare the relation between serum cholesterol, serum triglyceride, serum HDL and serum LDL in patients with and without gallstones.Methodology: A prospective, observational, hospital based study was conducted at Koshi Zonal Hospital from March 2017 to February 2018. Fifty four patients having gallstone (Group A) were compared with equal number of patients without gallstone (Group B). Data was entered into SPSS/MS Excel. Statistical Analysis was done by using Chi-square test. A 95% confidence interval was taken, and P value less than 0.05 was considered as statistically significant.Results: In Group A, 61%(33) patients were of age less than 45 years and 91%(49) were female. In group A, 3.7 %(2) and in group B, 7.4%(4) had raised serum cholesterol. Greater number of patient in group A had raised serum triglyclyceride and LDL as compared to group B. 18.5%(10) of group A had low serum HDL, and 9.3% (5) of group B had low serum HDL. Except for finding of gallstone more common in female, other findings had no statistical significance.Conclusion: There exists an inverse correlation between Serum Cholesterol and serum HDL with gallstone and positive association between serum Triglyceride and serum LDL with cholelithiasis. However the association could not reach the statistical significance.  BJHS 2018;3(2)6:418-422.

Gamma Knife surgery as sole treatment for multiple brain metastases: 2-center retrospective review of 1508 cases meeting the inclusion criteria of the JLGK0901 multi-institutional prospective study

2010 ◽  
Vol 113 (Special_Supplement) ◽  
pp. 48-52 ◽  
Author(s):  
Toru Serizawa ◽  
Masaaki Yamamoto ◽  
Yasunori Sato ◽  
Yoshinori Higuchi ◽  
Osamu Nagano ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Gamma Knife ◽  
Class Ii ◽  
Hazard Ratio ◽  
Gamma Knife Surgery ◽  
Inclusion Criteria ◽  
Primary Tumors ◽  
Poor Prognostic Factor ◽  
Group A ◽  
Group B

Object The authors retrospectively reviewed the results of Gamma Knife surgery (GKS) used as the sole treatment for brain metastases in patients who met the eligibility criteria for the ongoing JLGK0901 multi-institutional prospective trial. They also discuss the anticipated results of the JLGK0901 study. Methods Data from 1508 consecutive cases were analyzed. All of the patients were treated at the Gamma Knife House of Chiba Cardiovascular Center or the Mito Gamma House of Katsuta Hospital between 1998 and 2007 and met the following JLGK0901 inclusion criteria: 1) newly diagnosed brain metastases, 2) 1–10 brain lesions, 3) less than 10 cm3 volume of the largest tumor, 4) no more than 15 cm3 total tumor volume, 5) no findings of CSF dissemination, and 6) no impairment of activities of daily living (Karnofsky Performance Scale score < 70) due to extracranial disease. At the initial treatment, all visible lesions were irradiated with GKS without upfront whole-brain radiation therapy. Thereafter, gadolinium-enhanced MR imaging was performed every 2–3 months, and new distant lesions were appropriately retreated with GKS. Patients were divided into groups according to numbers of tumors: Group A, single lesions (565 cases); Group B, 2–4 tumors (577 cases); and Group C, 5–10 tumors (366 cases). The differences in overall survival (OS) were compared between groups. Results The median age of the patients was 66 years (range 19–96 years). There were 963 men and 545 women. The primary tumors were in the lung in 1114 patients, gastrointestinal tract in 179, breast in 105, urinary tract in 66, and other sites in 44. The overall mean survival time was 0.78 years (0.99 years for Group A, 0.68 years for Group B, and 0.62 years for Group C). The differences between Groups A and B (p < 0.0001) and between Groups B and C (p = 0.0312) were statistically significant. Multivariate analysis revealed significant prognostic factors for OS to be sex (poor prognostic factor: male, p < 0.0001), recursive partitioning analysis class (Class I vs Class II and Class II vs III, both p < 0.0001), primary site (lung vs breast, p = 0.0047), and number of tumors (Group A vs Group B, p < 0.0001). However, no statistically difference was detected between Groups B and C (p = 0.1027, hazard ratio 1.124, 95% CI 0.999–1.265). Conclusions The results of this retrospective analysis revealed an upper CI of 1.265 for the hazard ratio, which was lower than the 1.3 initially set by the JLGK0901 study. The JLGK0901 study is anticipated to show noninferiority of GKS as sole treatment for patients with 5–10 brain metastases compared with those with 2–4 in terms of OS.

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