Brain metastases treated with radiosurgery or hypofractionated stereotactic radiotherapy: outcomes and predictors of survival
Introduction To assess treatment outcome and prognostic factors associated with prolonged survival in patients with brain metastases (BM) treated with stereotactic radiosurgery (SRS) or hypofractionated stereotactic radiotherapy (HFSRT). Methods/Patients This study retrospectively reviewed 200 patie...
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| Published in | Clinical & translational oncology Vol. 22; no. 10; pp. 1809 - 1817 |
|---|---|
| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Cham
Springer International Publishing
01.10.2020
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| Subjects | |
| Online Access | Get full text |
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| Abstract | Introduction
To assess treatment outcome and prognostic factors associated with prolonged survival in patients with brain metastases (BM) treated with stereotactic radiosurgery (SRS) or hypofractionated stereotactic radiotherapy (HFSRT).
Methods/Patients
This study retrospectively reviewed 200 patients with 324 BM treated with one fraction (15–21 Gy) or 5–10 fractions (25–40 Gy) between January 2010 and August 2016. 26.5% of patients received whole brain radiotherapy (WBRT) and 25% initial surgery. Demographics, prognostic scales, systemic and local controls, patterns of relapse and rescue, toxicity, and cause of death were analyzed. A stratified analysis by primary tumor was done.
Results
Median overall survival (OS) was 8 months from SRS/HFSRT. Breast cancer patients had a median OS of 17 months, followed by renal (11 months), lung (8 months), colorectal (5 months), and melanoma (4 months). The univariate analysis showed improved OS in females (
p
0.004), RPA I–II (
p
< 0.001) initial surgery (
p
< 0.001), absence of extracranial disease (
p
0.023), and good disease control (
p
0
.
002). There were no differences in OS or local control between SRS and HFSRT or in patients receiving WBRT. Among 44% of brain recurrences, 11% were in field. 174 patients died, 10% from confirmed intracranial progression.
Conclusions
SRS and HSFRT are equally effective and safe for the treatment of BM, with no exceptions among different primary tumors. Disease control, surgery, age, and prognostic scales correlated with OS. However, the lack of survival benefit regarding WBRT might become logical evidence for its omission in a subset of patients. |
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| AbstractList | INTRODUCTIONTo assess treatment outcome and prognostic factors associated with prolonged survival in patients with brain metastases (BM) treated with stereotactic radiosurgery (SRS) or hypofractionated stereotactic radiotherapy (HFSRT). METHODS/PATIENTSThis study retrospectively reviewed 200 patients with 324 BM treated with one fraction (15-21 Gy) or 5-10 fractions (25-40 Gy) between January 2010 and August 2016. 26.5% of patients received whole brain radiotherapy (WBRT) and 25% initial surgery. Demographics, prognostic scales, systemic and local controls, patterns of relapse and rescue, toxicity, and cause of death were analyzed. A stratified analysis by primary tumor was done. RESULTSMedian overall survival (OS) was 8 months from SRS/HFSRT. Breast cancer patients had a median OS of 17 months, followed by renal (11 months), lung (8 months), colorectal (5 months), and melanoma (4 months). The univariate analysis showed improved OS in females (p 0.004), RPA I-II (p < 0.001) initial surgery (p < 0.001), absence of extracranial disease (p 0.023), and good disease control (p 0.002). There were no differences in OS or local control between SRS and HFSRT or in patients receiving WBRT. Among 44% of brain recurrences, 11% were in field. 174 patients died, 10% from confirmed intracranial progression. CONCLUSIONSSRS and HSFRT are equally effective and safe for the treatment of BM, with no exceptions among different primary tumors. Disease control, surgery, age, and prognostic scales correlated with OS. However, the lack of survival benefit regarding WBRT might become logical evidence for its omission in a subset of patients. Introduction To assess treatment outcome and prognostic factors associated with prolonged survival in patients with brain metastases (BM) treated with stereotactic radiosurgery (SRS) or hypofractionated stereotactic radiotherapy (HFSRT). Methods/Patients This study retrospectively reviewed 200 patients with 324 BM treated with one fraction (15–21 Gy) or 5–10 fractions (25–40 Gy) between January 2010 and August 2016. 26.5% of patients received whole brain radiotherapy (WBRT) and 25% initial surgery. Demographics, prognostic scales, systemic and local controls, patterns of relapse and rescue, toxicity, and cause of death were analyzed. A stratified analysis by primary tumor was done. Results Median overall survival (OS) was 8 months from SRS/HFSRT. Breast cancer patients had a median OS of 17 months, followed by renal (11 months), lung (8 months), colorectal (5 months), and melanoma (4 months). The univariate analysis showed improved OS in females ( p 0.004), RPA I–II ( p < 0.001) initial surgery ( p < 0.001), absence of extracranial disease ( p 0.023), and good disease control ( p 0 . 002). There were no differences in OS or local control between SRS and HFSRT or in patients receiving WBRT. Among 44% of brain recurrences, 11% were in field. 174 patients died, 10% from confirmed intracranial progression. Conclusions SRS and HSFRT are equally effective and safe for the treatment of BM, with no exceptions among different primary tumors. Disease control, surgery, age, and prognostic scales correlated with OS. However, the lack of survival benefit regarding WBRT might become logical evidence for its omission in a subset of patients. To assess treatment outcome and prognostic factors associated with prolonged survival in patients with brain metastases (BM) treated with stereotactic radiosurgery (SRS) or hypofractionated stereotactic radiotherapy (HFSRT). This study retrospectively reviewed 200 patients with 324 BM treated with one fraction (15-21 Gy) or 5-10 fractions (25-40 Gy) between January 2010 and August 2016. 26.5% of patients received whole brain radiotherapy (WBRT) and 25% initial surgery. Demographics, prognostic scales, systemic and local controls, patterns of relapse and rescue, toxicity, and cause of death were analyzed. A stratified analysis by primary tumor was done. Median overall survival (OS) was 8 months from SRS/HFSRT. Breast cancer patients had a median OS of 17 months, followed by renal (11 months), lung (8 months), colorectal (5 months), and melanoma (4 months). The univariate analysis showed improved OS in females (p 0.004), RPA I-II (p < 0.001) initial surgery (p < 0.001), absence of extracranial disease (p 0.023), and good disease control (p 0.002). There were no differences in OS or local control between SRS and HFSRT or in patients receiving WBRT. Among 44% of brain recurrences, 11% were in field. 174 patients died, 10% from confirmed intracranial progression. SRS and HSFRT are equally effective and safe for the treatment of BM, with no exceptions among different primary tumors. Disease control, surgery, age, and prognostic scales correlated with OS. However, the lack of survival benefit regarding WBRT might become logical evidence for its omission in a subset of patients. |
| Author | García-Berrocal, M. I. Zapata, I. Magallón, M. R. Expósito, M. J. Romero, J. Rincón, D. F. Sallabanda, M. García-Jarabo, V. |
| Author_xml | – sequence: 1 givenname: M. orcidid: 0000-0003-4058-5675 surname: Sallabanda fullname: Sallabanda, M. email: msallabanda@gmail.com organization: Radiation Oncology Department, Hospital Puerta de Hierro Majadahonda – sequence: 2 givenname: M. I. surname: García-Berrocal fullname: García-Berrocal, M. I. organization: Radiation Oncology Department, Hospital Puerta de Hierro Majadahonda – sequence: 3 givenname: J. surname: Romero fullname: Romero, J. organization: Radiation Oncology Department, Hospital Puerta de Hierro Majadahonda – sequence: 4 givenname: V. surname: García-Jarabo fullname: García-Jarabo, V. organization: Radiation Oncology Department, Hospital Puerta de Hierro Majadahonda – sequence: 5 givenname: M. J. surname: Expósito fullname: Expósito, M. J. organization: Radiation Oncology Department, Hospital Puerta de Hierro Majadahonda – sequence: 6 givenname: D. F. surname: Rincón fullname: Rincón, D. F. organization: Radiation Oncology Department, Hospital Puerta de Hierro Majadahonda – sequence: 7 givenname: I. surname: Zapata fullname: Zapata, I. organization: Radiation Oncology Department, Hospital Puerta de Hierro Majadahonda – sequence: 8 givenname: M. R. surname: Magallón fullname: Magallón, M. R. organization: Radiation Oncology Department, Hospital Puerta de Hierro Majadahonda |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/32124243$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1007_s12094_020_02544_y crossref_primary_10_1159_000513975 crossref_primary_10_1093_noajnl_vdab021 crossref_primary_10_1007_s11060_022_04185_3 crossref_primary_10_3389_fonc_2022_762230 crossref_primary_10_1177_11795549231222362 crossref_primary_10_3171_2021_10_JNS211410 crossref_primary_10_1016_j_adro_2024_101475 |
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| Keywords | Stereotactic radiosurgery Brain metastases Hypofractionated stereotactic radiotherapy Brain relapse |
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To assess treatment outcome and prognostic factors associated with prolonged survival in patients with brain metastases (BM) treated with... To assess treatment outcome and prognostic factors associated with prolonged survival in patients with brain metastases (BM) treated with stereotactic... INTRODUCTIONTo assess treatment outcome and prognostic factors associated with prolonged survival in patients with brain metastases (BM) treated with... |
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| Title | Brain metastases treated with radiosurgery or hypofractionated stereotactic radiotherapy: outcomes and predictors of survival |
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