Patients with long-term control of systemic disease are a favorable prognostic group for treatment of brain metastases with SRS alone.

Patients with long-term control of systemic disease are a favorable prognostic group for treatment of brain metastases with SRS alone.

World Neurosurg. 2016 Nov 9;:

Authors: Ebner DK, Gorovets D, Rava P, Cielo D, Kinsella TJ, DiPetrillo TA, Hepel JT

Abstract
BACKGROUND: Stereotactic radiosurgery (SRS) alone is an attractive option for treatment of brain metastases that avoids whole brain irradiation (WBRT)-associated morbidity, but is limited by regional CNS failures and short survival in some patients. We evaluated a subgroup of patients with controlled systemic disease that may represent a favorable patient population for SRS alone.
METHODS: All patients with brain metastases treated with SRS without WBRT at our institution between 2004 and 2014 were grouped into two cohorts, those with controlled systemic disease for ≥1yr (CSD) prior to presentation with brain metastases and those without (USD). Rates of local and regional CNS failure, and overall survival were assessed with chi-square and Student's t tests. Cox regression analysis was performed to evaluate independent predictors of regional control and overall survival.
RESULTS: A total of 294 patients underwent SRS to 697 lesions, of which 65 patients had CSD. Median follow-up was 9.7 mos. There was no difference in local control between the two cohorts (p=0.795). Regional CNS control was significantly better for patients with CSD, 68% vs. 48% (p=0.001). Overall survival at 1 and 5 years for CSD were 65% and 13%, with USD yielding 41% and 7% (p<0.001). Multivariate analysis demonstrated that USD (relative CSD) independently predicts regional failure (HR1.75; p=0.008) and shorter overall survival (HR1.55; p=0.007).
CONCLUSIONS: Patients presenting with brain metastases after ≥1 year of primary and systemic disease control represent a particularly favorable cohort, with lower regional CNS failure and prolonged survival, for an approach of SRS alone.

PMID: 27838432 [PubMed - as supplied by publisher]

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