Local Control and Survival Outcomes After Stereotactic Radiosurgery for Brain Metastases From Gastrointestinal Primaries: An International Multicenter Analysis

Abstract

BACKGROUND: There are limited data regarding outcomes for patients with gastrointestinal (GI) primaries and brain metastases treated with stereotactic radiosurgery (SRS). OBJECTIVE: To examine clinical outcomes after SRS for patients with brain metastases from GI primaries and evaluate potential prognostic factors. METHODS: The International Radiosurgery Research Foundation centers were queried for patients with brain metastases from GI primaries managed with SRS. Primary outcomes were local control (LC) and overall survival (OS). Kaplan-Meier analysis was used for univariate analysis (UVA) of prognostic factors. Factors significant on UVA were evaluated with a Cox multivariate analysis proportional hazards model. Logistic regressions were used to examine correlations with RN. RESULTS: We identified 263 eligible patients with 543 brain metastases. Common primary sites were rectal (31.2%), colon (31.2%), and esophagus (25.5%) with a median age of 61.6 years (range: 37-91.4 years) and a median Karnofsky performance status (KPS) of 90% (range: 40%-100%). One-year and 2-year LC rates were 83.5% (95% CI: 78.9%-87.1%) and 73.0% (95% CI: 66.4%-78.5%), respectively. On UVA, age >65 years (P = .001), dose <20 Gy (P = .006) for single-fraction plans, KPS <90% (P < .001), and planning target volume ≥2cc (P = .007) were associated with inferior LC. All factors other than dose were significant on multivariate analysis (P ≤ .002). One-year and 2-year OS rates were 68.0% (95% CI: 61.5%-73.6%) and 31.2% (95% CI: 24.6%-37.9%), respectively. Age > 65 years (P = .006), KPS <90% (P = .005), and extracranial metastases (P = .05) were associated with inferior OS. CONCLUSION: SRS resulted in comparable LC with common primaries. Age and KPS were associated with both LC and OS with planning target volume and extracranial metastases correlating with LC and OS, respectively. These factors should be considered in GI cancer patient selection for SRS.

Stereotactic Radiosurgery for Patients with Brain Metastases from Hepatopancreaticobiliary Cancers

“…Response to SRS has been related to several factors including tumor histology and tumor volume, history of prior WBRT, and SRS margin dose [21,22]. The current SRS LTC rates for brain metastases from various primary cancers in the literature consistently exceed 85% with a median margin dose range of 18-24 Gy [7,8,23]. However, using a median margin dose of 18 Gy (range: 10-20), Paudel et al [5] recorded 12-month LTC of 57.21% for 53 patients with brain metastases from only gastrointestinal primary cancers, with increased control rates for higher radiation delivery doses.…”

Five-Fraction Radiosurgery Using a Biologically Equivalent Dose of a Single Fraction of 24 Gy for a 3-cm Parasagittal Para-Central Sulcus Brain Metastasis From Adenocarcinoma of the Cecum

“…Although total en bloc resection (while preserving function) of the BM is preferable for immediate decompression and symptom improvement, a superior cerebral vein crossing directly above the lesion and draining into the superior sagittal sinus and/or poorly demarcated brain-tumor interface with profound microscopic brain invasion can compromise safe total resection [ 10 ]. Given the generally unfavorable radiosensitivity, achieving long-term local control and safety of such a BM from colorectal cancer is also challenging for stereotactic radiosurgery (SRS) [ 2 , 11 ].…”