Daniel M Trifiletti1, Cheng-Chia Lee2, Neil Shah3, Nirav V Patel3, Shao-Ching Chen2, Jason P Sheehan4. 1. Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia, USA. Electronic address: daniel.trifiletti@gmail.com. 2. Department of Neurosurgery, Neurological Institute, Taipei Veteran General Hospital, Taipei, Taiwan. 3. Department of Radiation Oncology, University of Virginia, Charlottesville, Virginia, USA. 4. Department of Neurological Surgery, University of Virginia, Charlottesville, Virginia, USA.
Abstract
OBJECTIVE: Although brainstem metastases are thought to portend an inferior prognosis compared to non-brainstem brain metastases, there is limited evidence to support this claim, particularly in the modern radiosurgical era. METHODS: We collected the clinical data for 500 patients with brain metastases treated at our institution with stereotactic radiosurgery (SRS). All patients received SRS to at least one brain metastasis, and all brainstem metastases underwent SRS. After propensity score matching, clinical characteristics and overall survival were calculated and compared between groups. RESULTS: Three hundred sixteen patients with brain metastases were analyzed after matching (143 with brainstem involvement and 173 without). Patients with brainstem metastases lived shorter after first SRS than patients without brainstem metastases did (median 4.4 and 6.5 months, respectively; P = 0.01), and they were more likely to have received whole brain irradiation (P = 0.003). Patients with a single metastasis did not survive longer than patients with multiple brain metastases if there was brainstem involvement (P = 0.45). The incidence of new extracranial disease and severe toxicity after SRS did not differ between groups. CONCLUSIONS: The survival of patients with brain metastases is inferior after a metastatic lesion develops within the brainstem, despite favorable local control with brainstem SRS. The brainstem location should be considered a negative prognostic factor for survival after SRS, and it could result from the eloquence of this location. Future research could identify the clinically life-limiting component of brainstem metastases.
OBJECTIVE: Although brainstem metastases are thought to portend an inferior prognosis compared to non-brainstem brain metastases, there is limited evidence to support this claim, particularly in the modern radiosurgical era. METHODS: We collected the clinical data for 500 patients with brain metastases treated at our institution with stereotactic radiosurgery (SRS). All patients received SRS to at least one brain metastasis, and all brainstem metastases underwent SRS. After propensity score matching, clinical characteristics and overall survival were calculated and compared between groups. RESULTS: Three hundred sixteen patients with brain metastases were analyzed after matching (143 with brainstem involvement and 173 without). Patients with brainstem metastases lived shorter after first SRS than patients without brainstem metastases did (median 4.4 and 6.5 months, respectively; P = 0.01), and they were more likely to have received whole brain irradiation (P = 0.003). Patients with a single metastasis did not survive longer than patients with multiple brain metastases if there was brainstem involvement (P = 0.45). The incidence of new extracranial disease and severe toxicity after SRS did not differ between groups. CONCLUSIONS: The survival of patients with brain metastases is inferior after a metastatic lesion develops within the brainstem, despite favorable local control with brainstem SRS. The brainstem location should be considered a negative prognostic factor for survival after SRS, and it could result from the eloquence of this location. Future research could identify the clinically life-limiting component of brainstem metastases.
Authors: Daniel M Trifiletti; Cheng-Chia Lee; Hideyuki Kano; Jonathan Cohen; James Janopaul-Naylor; Michelle Alonso-Basanta; John Y K Lee; Gabriela Simonova; Roman Liscak; Amparo Wolf; Svetlana Kvint; Inga S Grills; Matthew Johnson; Kang-Du Liu; Chung-Jung Lin; David Mathieu; France Héroux; Danilo Silva; Mayur Sharma; Christopher P Cifarelli; Christopher N Watson; Joshua D Hack; John G Golfinos; Douglas Kondziolka; Gene Barnett; L Dade Lunsford; Jason P Sheehan Journal: Int J Radiat Oncol Biol Phys Date: 2016-06-15 Impact factor: 7.038
Authors: Daniel M Trifiletti; M Sean Peach; Zhiyuan Xu; Ronald Kersh; Timothy N Showalter; Jason P Sheehan Journal: J Neurooncol Date: 2017-05-31 Impact factor: 4.130
Authors: Eduardo M Marchan; Jennifer Peterson; Terence T Sio; Kaisorn L Chaichana; Anna C Harrell; Henry Ruiz-Garcia; Anita Mahajan; Paul D Brown; Daniel M Trifiletti Journal: Front Oncol Date: 2018-08-31 Impact factor: 6.244
Authors: Ajay Patel; Homan Mohammadi; Tuo Dong; Kevin Ren-Yeh Shiue; Douglas Frye; Yi Le; Shaheryar Ansari; Gordon A Watson; James C Miller; Tim Lautenschlaeger Journal: CNS Oncol Date: 2017-12-14