Factors correlating with survival following adjuvant or definitive radiosurgery for large brain metastases

Abstract

Background We sought to identify variates correlating with overall survival (OS) in patients treated with surgery (S) plus adjuvant stereotactic radiosurgery (SRS) versus definitive SRS for large (>4cc) brain metastases (BrM). Methods We used univariate (UVA) and multivariate analyses (MVA) to identify survival correlates among eligible patients identified from a prospective registry and compared definitive SRS to S+ adjuvant SRS cohorts using propensity score-matched analysis (PSMA). Secondary outcomes were measured using the cumulative incidence (CI) method. Results We identified 364 patients; 127 and 237 were treated with S+SRS and definitive SRS, respectively. On UVA, SRS alone [HR1.73 (1.35,2.22) P<0.001), BrM quantity [HR 1.13 (1.06-1.22) (P<0.001)]; performance status (PS) [HR 2.78 (1.73-4.46) (P<0.001)]; extracranial disease (ECD) [HR 1.82 (1.37,2.40) (P<0.001)]; and receipt of systemic treatment after BrM therapy, [HR 0.58 (0.46-073) (P<0.001)] correlated with OS. On MVA, SRS alone [HR 1.81 (1.19,2.74) (P<0.0054)], SRS target volume [HR 1.03 (1.01,1.06) (P<0.0042)], and receipt of systemic treatment [HR 0.68 (0.50,0.93) (P<0.015)] correlated with OS. When PSMA was used to balance ECD, BrM quantity, PS, and SRS target volume, SRS alone remained correlated with worsened OS [HR 1.62 (1.20-2.19) (P=0.0015)]. CI of local failure requiring resection at 12 months was 3% versus 7% for S+SRS and SRS cohorts, respectively [(HR 2.04 (0.89-4.69) (P =0.091)]. CI of pachymeningeal failure at 12 months was 16% versus 0% for S+SRS and SRS. Conclusion SRS target volume, receipt of systemic therapies, and treatment with S+SRS instead of definitive SRS correlated with improved survival in patients with large BrM.

Anatomical and surgical characteristics correlate with pachymeningeal failure in patients with brain metastases after neurosurgical resection and adjuvant stereotactic radiosurgery

“…Pachymeningeal failure is an emerging pattern of failure, distinct from the classical (sugarcoated or linear) leptomeningeal failure (cLMF), and unique to postoperative patients (9) [12]. Past studies did not differentiate between cLMF and PMF [16-18].…”

“…This scheme was used for cavities until the fractionated SRS (F-SRS) technique was implemented in our center in 2017, using the ICON frameless system, utilizing the following dosing regimen: 4-<10cc 27Gy/3, 10-< 20cc 24Gy/3, and > 20cc 21Gy/3. Our SRS treatment procedure for cavities has been previously published [12]. We generally use the contouring guidelines for cavity SRS by Soliman et al [13], which recommends including the surgical tract (in addition to the surgical cavity) and a CTV expansion of 1-10mm based on preoperative tumor contact with venous sinus or dura.…”

Analysis of Key Clinical Variables and Radiological Manifestations Associated with the Treatment Response of Patients with Brain Metastases to Stereotactic Radiosurgery

“…The main concern of previous studies was the factors influencing the survival of patients with BM after SRS treatment [ 9 , 10 , 11 , 12 , 13 , 14 ]. These findings were important, but as the Guidelines for Multiple Brain Metastases Radiosurgery [ 15 ] reported, although the addition of radiosurgery improves local intracranial disease control, this is of uncertain clinical benefit because, for most patients, survival depends on extracranial disease control.…”