Outcomes in Patients with Intact and Resected Brain Metastasis Treated with 5-Fraction Stereotactic Radiosurgery

• DOI: 10.1016/j.adro.2022.101166
• Publication Date: 2022-12-30T01:20:41Z
• Authors: David J. Carpenter; Andrew T. Fairchild; Justus D. Adamson; Peter E. Fecci; John H. Sampson; James E. Herndon; Jordan A. Torok; Trey C. Mullikin; Grace J. Kim; Zachary J. Reitman; John P. Kirkpatrick; Scott R. Floyd
• Keywords: Interquartile range; Cumulative incidence

Hypofractionated stereotactic radiosurgery (HF-SRS) with or without surgical resection is potentially a preferred treatment for larger symptomatic brain metastases (BMs). Herein, we report clinical outcomes and predictive factors following HF-SRS.Patients undergoing HF-SRS intact (iHF-SRS) resected (rHF-SRS) BMs from 2008 to 2018 were retrospectively identified. Linear accelerator-based image-guided consisted of 5 fractions at 5, 5.5, 6 Gy per fraction. Time local progression (LP), time distant (DBP), overall survival (OS) calculated. Cox models assessed effect on OS. Fine Gray's cumulative incidence model competing events examined LP DBP. The occurrence leptomeningeal disease (LMD) was determined. Logistic regression predictors LMD.Among 445 patients, median age 63.5 years; 87% had Karnofsky performance status ≥70. Fifty-three % patients underwent resection, 75% received Patients higher (90-100, 41 vs 30%), less extracranial (absent, 25 13%), fewer (multiple, 32 67%). Median diameter the dominant BM 3.0 cm (interquartile range, 1.8-3.6 cm) 4.6 3.9-5.5 BMs. OS 5.1 months (95% confidence interval [CI], 4.3-6.0) iHF-SRS 12.8 CI, 10.8-16.2) rHF-SRS (P < .01). Cumulative 14.5% 18 11.4-18.0%), significantly associated greater total GTV (hazard ratio, 1.12; 95% 1.05-1.20) iFR-SRS, recurrent versus newly diagnosed across all 2.28; 1.01-5.15). DBP than = .01), respective 24-month rates 50.0 43.3-56.3) 35.7% 29.2-42.2). LMD (57 total; 33% nodular, 67% diffuse) observed in 17.1% 8.1% cases (odds 2.46; 1.34-4.53). Any radionecrosis grade 2+ 14 8% cases, respectively.HF-SRS demonstrated favorable LC postoperative settings. Corresponding RN comparable those other studies.