Melanoma brain metastasis: the impact of stereotactic radiosurgery, BRAF mutational status, and targeted and/or immune-based therapies on treatment outcome

OBJECTIVEThe goal of this study was to investigate the impact of stereotactic radiosurgery (SRS), BRAF status, and targeted and immune-based therapies on the recurrence patterns and factors associated with overall survival (OS) among patients with melanoma brain metastasis (MBM).METHODSA total of 366 patients were treated for 1336 MBMs; a lesion-based analysis was performed on 793 SRS lesions. The BRAF status was available for 78 patients: 35 had BRAFmut and 43 had BRAF wild-type (BRAF-WT) lesions. The Kaplan-Meier method evaluated unadjusted OS; cumulative incidence analysis determined the incidences of local failure (LF), distant failure, and radiation necrosis (RN), with death as a competing risk.RESULTSThe 12-month OS was 24% (95% CI 20%–29%). On multivariate analysis, younger age, lack of extracranial metastases, better Karnofsky Performance Status score, and fewer MBMs, as well as treatment with BRAF inhibitors (BRAFi), anti–PD-1/CTLA-4 therapy, or cytokine therapy were significantly associated with OS. For patients who underwent SRS, the 12-month LF rate was lower among those with BRAFmut lesions (6%, 95% CI 2%–11%) compared with those with BRAF-WT lesions (22%, 95% CI 13%–32%; p < 0.01). The 12-month LF rates among lesions treated with BRAFi and PD-1/CTLA-4 agents were 1% (95% CI 1%–4%) and 7% (95% CI 1%–13%), respectively. On multivariate analysis, BRAF inhibition within 30 days of SRS was protective against LF (HR 0.08, 95% CI 0.01–0.55; p = 0.01). The 12-month rates of RN were low among lesions treated with BRAFi (0%, 95% CI 0%–0%), PD-1/CTLA-4 inhibitors (2%, 95% CI 1%–5%), and cytokine therapies (6%, 95% CI 1%–13%).CONCLUSIONSPrognostic schema should incorporate BRAFi or immunotherapy status and use of targeted therapies. Treatment with a BRAF inhibitor within 4 weeks of SRS improves local control without an increased risk of RN.

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Stereotactic Radiosurgery for Renal Cancer Brain Metastasis: Prognostic Factors and the Role of Whole-Brain Radiation and Surgical Resection

Journal of Oncology ◽

10.1155/2015/636918 ◽

2015 ◽

Vol 2015 ◽

pp. 1-13 ◽

Cited By ~ 12

Author(s):

Franziska M. Ippen ◽

Anand Mahadevan ◽

Eric T. Wong ◽

Erik J. Uhlmann ◽

Soma Sengupta ◽

...

Keyword(s):

Prognostic Factors ◽

Brain Metastasis ◽

Brain Metastases ◽

Stereotactic Radiosurgery ◽

Surgical Resection ◽

Karnofsky Performance Status ◽

Performance Status ◽

Patient Treatment ◽

Consecutive Series ◽

Additional Surgery

Background. Renal cell carcinoma is a frequent source of brain metastasis. We present our consecutive series of patients treated with Stereotactic Radiosurgery (SRS) and analyse prognostic factors and the interplay of WBRT and surgical resection.Methods. This is a retrospective study of 66 patients with 207 lesions treated with the Cyberknife radiosurgery system in our institution. The patients were followed up with imaging and clinical examination 1 month and 2-3 months thereafter for the brain metastasis. Patient, treatment, and outcomes characteristics were analysed.Results. 51 male (77.3%) and 15 female (22.7%) patients, with a mean age of 58.9 years (range of 31–85 years) and a median Karnofsky Performance Status (KPS) of 90 (range of 60–100), were included in the study. The overall survival was 13.9 months, 21.9 months, and 5.9 months for the patients treated with SRS only, additional surgery, and WBRT, respectively. The actuarial 1-year Local Control rates were 84%, 94%, and 88% for SRS only, for surgery and SRS, and for WBRT and additional SRS, respectively.Conclusions. Stereotactic radiosurgery is a safe and effective treatment option in patients with brain metastases from RCC. In case of a limited number of brain metastases, surgery and SRS might be appropriate.

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Prognostic factors in locally advanced colon cancer treated by extended resection

Revista do Hospital das Clínicas ◽

10.1590/s0041-87812004000600009 ◽

2004 ◽

Vol 59 (6) ◽

pp. 361-368 ◽

Cited By ~ 10

Author(s):

René A.C. Vieira ◽

Ademar Lopes ◽

Paulo A.C. Almeida ◽

Benedito M. Rossi ◽

Wilson T. Nakagawa ◽

...

Keyword(s):

Overall Survival ◽

Multivariate Analysis ◽

Colon Carcinoma ◽

Karnofsky Performance Status ◽

Performance Status ◽

Locally Advanced ◽

Survival Rates ◽

Postoperative Mortality ◽

The Impact ◽

Overall Survival Rates

The impact of clinical, pathologic, and surgical variables on the postoperative morbidity, mortality, and survival of patients undergoing extended resections of colon carcinoma were evaluated. METHODS: The medical records of 95 patients who underwent extended resections for colon carcinoma between 1953 and 1996 were reviewed. In all cases, in addition to colectomy, 1 or more organs and/or structures were resected en bloc due to a macroscopically based suspicion of tumor invasion. The clinical, pathologic, and surgical parameters were analyzed. Overall survival rates were analyzed according to the method of Kaplan and Meier. Multivariate analysis was performed using the Cox proportional hazards model. RESULTS: Eighty-six patients were treated by curative surgeries and the remaining by palliative resections. Invasion of the organs and/or adjacent structures and regional lymph nodes was found microscopically in 48 and 31 patients, respectively. The median follow-up without postoperative mortality was 47.7 months. The 5-year overall survival rates was 52.6%. The 5-year overall survival rates for patients undergoing curative and palliative surgeries was 58.3% and 0%, respectively. The mean survival time in the palliative surgery group was 3.1 months. Multivariate analysis showed that Karnofsky performance status was strongly related to the risk of postoperative complications (P = .01), and postoperative deaths were associated with the type of surgery and Karnofsky performance status at the time of admission (P = .001). CONCLUSIONS: Some patients with locally advanced colon adenocarcinomas undergoing extended resections have a 5-year overall survival rates of 58.3%. Patients could benefit from palliative-intent procedures, but these measures should cautiously be indicated and avoided in patients with low Karnofsky performance status due to high rates of postoperative mortality and poor survival.

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Prognostic factors (PFs) of survival in a randomized phase III trial (MPACT) of weekly nab-paclitaxel (nab-P) plus gemcitabine (G) versus G alone in patients (pts) with metastatic pancreatic cancer (MPC).

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.4059 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. 4059-4059 ◽

Cited By ~ 4

Author(s):

Malcolm J. Moore ◽

Daniel D. Von Hoff ◽

Thomas J. Ervin ◽

Francis P. Arena ◽

E. Gabriela Chiorean ◽

...

Keyword(s):

Multivariate Analysis ◽

Liver Metastases ◽

Treatment Effect ◽

Karnofsky Performance Status ◽

Performance Status ◽

Univariate Analysis ◽

Phase Iii ◽

Risk Of Death ◽

Increased Risk ◽

Metastatic Sites

4059^ Background: In MPACT, pts who received nab-P + G vs G had improved overall survival (OS; median 8.5 vs 6.7 mo; HR 0.72; p= 0.000015). Here we assessed potential PFs of OS. Methods: 861 pts with MPC were randomized 1:1, stratified by region, presence of liver metastases, and Karnofsky performance status (KPS), to nab-P + G or G. OS was described in subgroups. A step-wise multivariate analysis (with significance level for entry of 0.20 and for stay of 0.10) was performed to evaluate the treatment effect and identify possible predictors of OS. Results: Pts with poorer PFs had a shorter median OS, consistent with the literature, and OS consistently favored nab-P + G in pts with these PFs (Table). Region of Eastern Europe, age ≥ 65 years, poorer KPS, presence of liver metastases, and number of metastatic sites all predicted OS (increased risk of death). The treatment effect remained significant (HR 0.72; 95% CI, 0.605 - 0.849; p < 0.0001, Cox proportional hazards [CPH] model). In another multivariate analysis in which baseline CA19-9 was added to the final model described above, the treatment effect HR was 0.67 (95% CI, 0.573 - 0.794; p < 0.0001, CPH model). Baseline CA19-9, a predictor of OS by univariate analysis, was not predictive after correction for the above factors. Conclusions: In MPACT, the most important predictors of OS were KPS, age, presence of liver metastases, number of metastatic sites, and region. After correcting for these factors, assignment to nab-P + G was an independent significant predictor of improved survival. Clinical trial information: NCT00844649. [Table: see text]

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Splenectomy in Patients with Chronic Myeloid Leukemia or Myeloproliferative Diseases: Outcomes, Complications and Prognostic Implications.

Blood ◽

10.1182/blood.v110.11.2553.2553 ◽

2007 ◽

Vol 110 (11) ◽

pp. 2553-2553

Author(s):

Constantine S. Tam ◽

Raphael E. Pollock ◽

John Manning ◽

Jorge Cortes ◽

Katherine I. Lin ◽

...

Keyword(s):

Multivariate Analysis ◽

Venous Thrombosis ◽

Performance Status ◽

Splenic Vein ◽

Chromosome 17 ◽

Monocyte Count ◽

Increased Risk ◽

Transfusion Dependency ◽

Lille Score ◽

The Impact

Abstract The results of splenectomy in 110 patients with myeloproliferative disorders (MPD) were analyzed to determine short-term outcome and complications, and long-term impact on AML transformation and survival. Thirty-one patients had CML in chronic(CP; n=10), accelerated(AP, n=10) or blast phase(BP, n=11); 60 myelofibrosis in CP(n=59) or BP(n=1); 8 CMML; and 11 other MPDs. Median characteristics (range): age 58 yrs (16–85), male 60%, time from diagnosis 6 months (0–187), 2 prior therapies (0–7), performance status 1 (0–3), B-symptoms 70%, transfusion-dependent 50%, spleen 15cm (0–30) below LCM. The number of indications for splenectomy was 1 in 44%, 2 in 40%, and ≥3 in 16%, with the most common indications being pain/ local symptoms (54%), anemia/ transfusion dependency (59%) and thrombocytopenia (39%). For patients with anemia/ transfusion-dependency, Hb improved ≥2g/dL &/or transfusion requirement decreased by half in 68% for a median of 13 months. For patients with thrombocytopenia, 66% improved platelet count by >30×10^9/L for a median of 18 months. No patient had deterioration in Hb or Plt post-splenectomy not otherwise explained by disease or concomitant therapy. Complications occurred in 58% patients with the most common being thrombocytosis >1000×10^9/L (17%), venous thrombosis (16%), pneumonia (10%), abdominal collection (9%), leucocytosis >150×10^9/L (6%), painful hepatomegaly (4%) and bleeding (3%). Sites of thrombosis were: 10 portal vein, 3 Budd-Chiari, 3 DVT/PE, 2 splenic vein and 1 SVC obstruction; 2 patients had multiple thrombosis sites. Patients with baseline platelets ≥150×10^9/L were more likely to develop platelets >1000×10^9/L postoperatively (39% v 6%, p<0.001), who in turn were at an increased risk of venous thrombosis (32% v 13%, p=0.05). Median survival was 19 months: most patients died of progressive disease, with only six deaths attributable to surgery, and the occurrence of surgical complications had no impact on survival (p=0.45). In order to assess the impact of splenectomy on AML risk and survival of myelofibrosis patients, we compared outcomes between 53 study patients and 267 control (non-splenectomized) patients from the MD Anderson MPD database. Patient with features of pre-terminal disease (blasts ≥10%, abnormal chromosome 17 or severe cytopenia) were excluded from this analysis. In this comparison, splenectomized myelofibrosis patients experienced inferior survival (median 21 v 46 months, p<0.001), with the difference remaining significant (HR 1.6 p=0.02) after accounting for age, cytogenetics, blast%, monocyte count and Lille score in a multivariate analysis. AML risk was also increased in splenectomized patients, but occurred in only a minority of patients (23% at 4 yrs, v 13% for controls, p=0.01), and splenectomy was not an independent factor for AML development after accounting for peripheral blood blast% (HR 1.3, p=0.008) and Lille score (HR 2.2 p=0.005) in multivariate analysis. The requirement of splenectomy for disease control is an independent predictor of poor outcome in patients with myelofibrosis.

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Cyberknife® hypofractionated stereotactic radiosurgery (CK-hSRS) as salvage treatment for brain metastases

Journal of Cancer Research and Clinical Oncology ◽

10.1007/s00432-021-03564-z ◽

2021 ◽

Author(s):

Sergej Telentschak ◽

Daniel Ruess ◽

Stefan Grau ◽

Roland Goldbrunner ◽

Niklas von Spreckelsen ◽

...

Keyword(s):

Brain Metastases ◽

Stereotactic Radiosurgery ◽

Poor Prognosis ◽

Karnofsky Performance Status ◽

Performance Status ◽

Salvage Treatment ◽

Treatment Modalities ◽

Large Tumor ◽

Fractionated Radiotherapy ◽

Hypofractionated Stereotactic Radiosurgery

Abstract Purpose The introduction of hypofractionated stereotactic radiosurgery (hSRS) extended the treatment modalities beyond the well-established single-fraction stereotactic radiosurgery and fractionated radiotherapy. Here, we report the efficacy and side effects of hSRS using Cyberknife® (CK-hSRS) for the treatment of patients with critical brain metastases (BM) and a very poor prognosis. We discuss our experience in light of current literature. Methods All patients who underwent CK-hSRS over 3 years were retrospectively included. We applied a surface dose of 27 Gy in 3 fractions. Rates of local control (LC), systemic progression-free survival (PFS), and overall survival (OS) were estimated using Kaplan–Meier method. Treatment-related complications were rated using the Common Terminology Criteria for Adverse Events (CTCAE). Results We analyzed 34 patients with 75 BM. 53% of the patients had a large tumor, tumor location was eloquent in 32%, and deep seated in 15%. 36% of tumors were recurrent after previous irradiation. The median Karnofsky Performance Status was 65%. The actuarial rates of LC at 3, 6, and 12 months were 98%, 98%, and 78.6%, respectively. Three, 6, and 12 months PFS was 38%, 32%, and 15%, and OS was 65%, 47%, and 28%, respectively. Median OS was significantly associated with higher KPS, which was the only significant factor for survival. Complications CTCAE grade 1–3 were observed in 12%. Conclusion Our radiation schedule showed a reasonable treatment effectiveness and tolerance. Representing an optimal salvage treatment for critical BM in patients with a very poor prognosis and clinical performance state, CK-hSRS may close the gap between surgery, stereotactic radiosurgery, conventional radiotherapy, and palliative care.

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RADT-23. IMPACT OF REIRRADIATION UTILIZING STEREOTACTIC RADIOSURGERY ON RECURRENT GLIOBLASTOMA

Neuro-Oncology ◽

10.1093/neuonc/noaa215.776 ◽

2020 ◽

Vol 22 (Supplement_2) ◽

pp. ii186-ii186

Author(s):

O’Dell Patrick ◽

H Nickols ◽

R LaRocca ◽

K Sinicrope ◽

D Sun ◽

...

Keyword(s):

Stereotactic Radiosurgery ◽

Median Survival ◽

High Performance ◽

Performance Status ◽

Treatment Options ◽

Methylation Status ◽

Initial Therapy ◽

Recurrent Glioblastoma ◽

Control Group ◽

The Impact

Abstract BACKGROUND Patients who have recurrent glioblastoma have limited treatment options. We conducted a retrospective review of patients with recurrent glioblastoma treated with standard initial radiation and temozolomide with tumor treating fields to investigate whether reirradiation using radiosurgery would be associated with improved outcomes. METHODS We reviewed the records of 54 consecutively treated patients with recurrent glioblastoma with ECOG 0 or 1 at recurrence and conducted Kaplan-Meier analysis with Log-rank testing to determine significance between groups. RESULTS We identified 24 patients who were treated without radiation therapy (control) while 30 patients underwent re-irradiation using radiosurgery (ReSRS) with a median total dose of 25Gy in five fractions. All patients had completed standard initial therapy, and there was no difference in the time to recurrence between the two groups (10 months for control, 15 months for ReSRS, [P = 0.17, HR for progression 0.65 (95% CI 0.38-1.13)]. A larger proportion of patients in the control arm (54%) had subtotal or gross total resection of the recurrence compared with the ReSRS group (44%, P < 0.05). The majority of patients had recurrence confirmed with biopsy (18/22 in control group, 25/31 in the ReSRS group). MGMT methylation status did not differ between control vs ReSRS (29% vs. 27%). ReSRS was associated with improved median survival from the time of first recurrence of 11.6 months versus 3.8 months in the control arm [P< 0.0001, HR for death 0.33 (95% CI 0.18-0.6)]. CONCLUSIONS In a group of patients with high performance status diagnosed with recurrent glioblastoma, reirradiation with stereotactic radiosurgery was associated with nearly one year median survival after recurrence. Additional analyses are warranted to determine the impact of concurrent systemic therapies with irradiation and underlying tumor or patient factors to predict outcomes.

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Postoperative ischemic changes following brain metastasis resection as measured by diffusion-weighted magnetic resonance imaging

Journal of Neurosurgery ◽

10.3171/2013.9.jns13596 ◽

2013 ◽

Vol 119 (6) ◽

pp. 1395-1400 ◽

Cited By ~ 17

Author(s):

Jens Gempt ◽

Julia Gerhardt ◽

Vivien Toth ◽

Stefanie Hüttinger ◽

Yu-Mi Ryang ◽

...

Keyword(s):

Brain Metastasis ◽

Brain Metastases ◽

Neurological Deficit ◽

Karnofsky Performance Status ◽

Performance Status ◽

Neurological Status ◽

Neurological Deficits ◽

Brain Irradiation ◽

Diffusion Weighted ◽

The Mean

Object Brain metastases occur in 10% to 40% of patients harboring cancer. In cases of neurosurgical metastasis resection, all postoperative neurological deterioration should be avoided. Reasons for postoperative deficits can be direct tissue damage due to resection, hemorrhage, venous congestive infarcts, or arterial ischemic events leading to tissue infarction. The aim of this study was to evaluate whether postoperative ischemic infarctions occur in surgery for brain metastasis and to determine their influence on new postoperative neurological deficits. Methods Patients who underwent resection of brain metastases and had preoperative and early postoperative (within 48 hours) MRI scans, including diffusion-weighted imaging sequences and apparent diffusion coefficient maps, between January 2009 and May 2012 were included in this study. Clinical and histopathological data (histopathological results, pre- and postoperative neurological status, and previous tumor-specific therapy) were recorded. Results One hundred twenty-two patients (56 male, 66 female) who underwent resection of brain metastases were included. The patients' mean age was 60 years (range 21–89 years). The mean time span from initial tumor diagnosis to resection of brain metastasis was 44 months (range 0–338 months). The mean preoperative Karnofsky Performance Status was 80% (exact mean 76% ± 17% [SD]), and the mean postoperative value was 80% (exact mean 78% ± 17%). Twelve (9.8%) of the 122 patients had postoperative permanent worsening of a neurological deficit or a new permanent neurological deficit; 44 (36.1%) of the 122 patients had postoperative ischemic lesions. When comparing patients with and without previous brain irradiation, 53.8% of patients with previous brain irradiation had ischemic lesions on postoperative imaging compared with 31.3% of patients without previous brain irradiation (p = 0.033). There was a significant association between ischemia and postoperative neurological status deterioration (transient or permanent); 13 (29.5%) of 44 patients with ischemic lesions had deterioration of their neurological status compared with 7 (9%) of the 78 patients who did not have ischemic lesions (p = 0.003). Conclusions This study demonstrates a high prevalence of vascular incidents in patients undergoing resection for metastatic brain disease. Patients harboring postoperative ischemic lesions detected by MRI have a higher rate of neurological deficits (transient or permanent). Patients who had previous irradiation therapy are at higher risk of developing postoperative ischemic lesions. A large number of postoperative neurological deficits are caused by ischemic incidents.

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Factors influencing the outcome of stereotactic radiosurgery in patients with five or more brain metastases

Current Oncology ◽

10.3747/co.26.4244 ◽

2019 ◽

Vol 26 (1) ◽

Cited By ~ 4

Author(s):

E. Hamel-Perreault ◽

D. Mathieu ◽

L. Masson-Cote

Keyword(s):

Brain Metastases ◽

Stereotactic Radiosurgery ◽

Karnofsky Performance Status ◽

Systemic Disease ◽

Performance Status ◽

Recursive Partitioning ◽

Nonsmall Cell Lung Cancer ◽

Factors Influencing ◽

Treatment Volume ◽

Extracranial Disease

Background Stereotactic radiosurgery (srs) for patients with 5 or more brain metastases (bmets) is a matter of debate. We report our results with that approach and the factors influencing outcome.Methods In the 103 patients who underwent srs for the treatment of 5 or more bmets, primary histology was nonsmall- cell lung cancer (57% of patients). All patients were grouped by Karnofsky performance status and recursive partitioning analysis (rpa) classification. In our cohort, 72% of patients had uncontrolled extracranial disease, and 28% had stable or responding systemic disease. Previous irradiation for 1–4 bmets had been given to 56 patients (54%). The mean number of treated bmets was 7 (range: 5–19), and the median cumulative bmets volume was 2 cm3 (range: 0.06–28 cm3).Results Multivariate analyses showed that stable extracranial disease (p < 0.001) and rpa (p = 0.022) were independent prognostic factors for overall survival (os). Moreover, a cumulative treated bmets volume of less than 6 cm3 (adjusted hazard ratio: 2.54; p = 0.006; 95% confidence interval: 1.30 to 4.99) was associated with better os. The total number of bmets had no effect on survival (p = 0.206). No variable was found to be predictive of local control. The rpa was significant (p = 0.027) in terms of distant recurrence.Conclusions Our study suggests that srs is a reasonable option for the management of patients with 5 or more bmets, especially with a cumulative treatment volume of less than 6 cm3.

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Navigated Intraoperative 2-Dimensional Ultrasound in High-Grade Glioma Surgery: Impact on Extent of Resection and Patient Outcome

Operative Neurosurgery ◽

10.1093/ons/opz203 ◽

2019 ◽

Cited By ~ 1

Author(s):

Alessandro Moiraghi ◽

Francesco Prada ◽

Alberto Delaidelli ◽

Ramona Guatta ◽

Adrien May ◽

...

Keyword(s):

Real Time ◽

Karnofsky Performance Status ◽

Performance Status ◽

Intraoperative Ultrasound ◽

High Grade Glioma ◽

Extent Of Resection ◽

High Grade ◽

Glioma Surgery ◽

Supratentorial Gliomas ◽

The Impact

Abstract BACKGROUND Maximizing extent of resection (EOR) and reducing residual tumor volume (RTV) while preserving neurological functions is the main goal in the surgical treatment of gliomas. Navigated intraoperative ultrasound (N-ioUS) combining the advantages of ultrasound and conventional neuronavigation (NN) allows for overcoming the limitations of the latter. OBJECTIVE To evaluate the impact of real-time NN combining ioUS and preoperative magnetic resonance imaging (MRI) on maximizing EOR in glioma surgery compared to standard NN. METHODS We retrospectively reviewed a series of 60 cases operated on for supratentorial gliomas: 31 operated under the guidance of N-ioUS and 29 resected with standard NN. Age, location of the tumor, pre- and postoperative Karnofsky Performance Status (KPS), EOR, RTV, and, if any, postoperative complications were evaluated. RESULTS The rate of gross total resection (GTR) in NN group was 44.8% vs 61.2% in N-ioUS group. The rate of RTV > 1 cm3 for glioblastomas was significantly lower for the N-ioUS group (P < .01). In 13/31 (42%), RTV was detected at the end of surgery with N-ioUS. In 8 of 13 cases, (25.8% of the cohort) surgeons continued with the operation until complete resection. Specificity was greater in N-ioUS (42% vs 31%) and negative predictive value (73% vs 54%). At discharge, the difference between pre- and postoperative KPS was significantly higher for the N-ioUS (P < .01). CONCLUSION The use of an N-ioUS-based real-time has been beneficial for resection in noneloquent high-grade glioma in terms of both EOR and neurological outcome, compared to standard NN. N-ioUS has proven usefulness in detecting RTV > 1 cm3.

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Evaluation of Prognostic Factors for Early Mortality After Stereotactic Radiosurgery for Brain Metastases: a Single Institutional Retrospective Review

Neurosurgery ◽

10.1093/neuros/nyx346 ◽

2017 ◽

Vol 83 (1) ◽

pp. 128-136 ◽

Cited By ~ 2

Author(s):

E Emily Bennett ◽

Michael A Vogelbaum ◽

Gene H Barnett ◽

Lilyana Angelov ◽

Samuel Chao ◽

...

Keyword(s):

Prognostic Factors ◽

Brain Metastases ◽

Stereotactic Radiosurgery ◽

Karnofsky Performance Status ◽

Systemic Disease ◽

Performance Status ◽

Early Death ◽

Tumor Type ◽

Prognostic Groups ◽

Prior Surgery

Abstract BACKGROUND Stereotactic radiosurgery (SRS) is used commonly for patients with brain metastases (BM) to improve intracranial disease control. However, survival of these patients is often dictated by their systemic disease course. The value of SRS becomes less clear in patients with anticipated short survival. OBJECTIVE To evaluate prognostic factors, which may predict early death (within 90 d) after SRS. METHODS A total of 1427 patients with BM were treated with SRS at our institution (2000-2012). There were 1385 cases included in this study; 1057 patients underwent upfront SRS and 328 underwent salvage SRS. The primary endpoint of the study was all-cause mortality within 90 d after first SRS. Multivariate analyses were performed to develop prognostic indices. RESULTS Two hundred sixty-six patients (19%, 95% confidence interval 17%-21%) died within 90 d after SRS. Multivariate analysis of upfront SRS patients showed that Karnofsky Performance Status, primary tumor type, extracranial metastases, age at SRS, boost treatment, total tumor volume, prior surgery, and interval from primary to BM were independent prognostic factors for 90-d mortality. The first 4 factors were also independent predictors in patients treated with salvage SRS. Based on these factors, an index was defined for each group that categorized patients into 3 and 2 prognostic groups, respectively. Ninety-day mortality was 5% to 7% in the most favorable cohort and 36% to 39% in the least favorable. CONCLUSION Indices based on readily available patient, clinical, and treatment factors that are highly predictive of early death in patients treated with upfront or salvage SRS can be calculated and used to define well-separated prognostic groups.

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