Single Institutional Experience of Stereotactic Radiosurgery Alone for First Brain Metastatic Event and Salvage of Second Brain Metastatic Event in a Community Setting with Review of the Literature

Abstract

PurposeTo document survival for patients treated with stereotactic radiosurgery (SRS) alone for brain metastases either at initial presentation or for salvage in conjunction with other known prognostic factors in a single institutional community setting with comparison to current literature.MethodsAll patients treated for brain metastases with SRS between October 2006 and October 2013 were reviewed. We identified 91 patients treated with SRS alone for first brain metastatic event (FBME) and 87 patients treated with SRS for second brain metastatic event (SBME). We excluded the 14 patients treated with SRS for both FBME and SBME to satisfy the independence assumption for comparison of groups. Patient demographics, including age, gender, primary cancer type, presence of extracranial metastases, number of brain metastases, initial site of metastases (brain vs. other), recursive partitioning analysis (RPA), and Karnofsky Performance status (KPS) were documented.ResultsThere were no significant differences in overall survival for patients treated with SRS for FBME compared with SBME (log-rank p = 0.9347). Univariate and multivariable Cox regression modeling revealed KPS (p = 0.0003) and RPA (p = 0.0143) were the only independent prognostic factors for survival. Specifically, patients with RPA 1 had a 61% decreased risk of death compared to those with RPA 3. Patients with RPA 2 had a 33% decreased risk of death compared to those with RPA 3. The 1-year survival rate was 36.5% for patients with RPA1, 33.3% for those with RPA 2, and 17.1% for those with RPA 3. Patients with KPS 90–100 had a 62% decreased risk of death compared to those with KPS < 70. The 1-year survival rate for patients KPS 90–100, 70–80, and <70 were 60.7, 24.6, and 16.7%, respectively.ConclusionNo difference in survival was noted for FBME and SBME with performance status, the single most important prognostic factor following SRS. Aggressive treatment should be considered for patients with good performance status regardless if presenting with FBME or SBME. Our results are consistent with single, multi-institutional, and randomized trials after literature review.

Laser interstitial thermal therapy as an adjunct therapy in brain tumors: A meta-analysis and comparison with stereotactic radiotherapy

“…For SRS review, a total of 1412 potentially relevant articles were identified. After examination of the titles, abstracts, and full texts, 21 studies (17 for BM [1,10,14,20,24,25,32,39,45,46,61,63,70,85,86] and 4 for rGBM [17,30,41,65] ) met inclusion criteria [Figures S1 and S2] for the PRISMA flow diagram of LITT and SRS included studies, respectively. In all studies, it was not clear if either patients or clinicians were blinded.…”

“…e close-out date was January 2019. Studies were included if (1) written in English, Portuguese, French, and Spanish, (2) LITT or SRS was the single therapy employed as treatment in an adult cohort (≤18 years old), and (3) presented in some measure, the median overall survival (MOS), progression-free survival (PFS), and adverse events related to treatment in patients. Retrospective studies, prospective analyses, and case series were included in the review.…”

“…Hawasli et al [27] described deterioration in postoperative KPS scores after LITT (mean, 74.1 ± 9.4 [before] and 63.8 ± 16.0 [after] LITT). On the contrary, KPS improvement after 14 days of LITT was described (increase of 13.3 points on the average) by Sloan et al [77] All SRS studies (one exception applied [55] ) described MOS, whereas, median PFS was reported in 11 studies [1,10,17,20,39,45,55,61,70,85,86] [Table 1]. No KPS scores or other neurological evaluations after SRS treatment were described.…”

Stereotactic Radiosurgery for Multiple Brain Metastases: Two Cases of Preserved Quality of Life

“…Even with the excellent outcomes of patients with good performance status and controlled extracranial disease following SRS alone for brain metastases, there is an increased risk of distant brain metastasis failure with the omission of WBRT. Nevertheless, patients who have regional failure after SRS can undergo effective salvage SRS with low morbidity and may have similar outcomes to those who experience first brain metastases with similar performance status [ 7 - 9 ]. Several studies have reported the efficacy of SRS after prior radiation and found similar prognostic factors to those reported in these prior studies, including younger age, longer interval from initial radiation therapy to salvage SRS, total tumor volume, and controlled extracranial disease.…”