BACKGROUND: Although patients with brain metastasis are treated with primary stereotactic radiosurgery (SRS), the use of salvage therapies and their consequence remains understudied. OBJECTIVE: To study the intracranial recurrence patterns and salvage therapies for patients who underwent multiple SRS courses. METHODS: A retrospective review was performed of 59 patients with brain metastases who underwent ≥3 SRS courses for new lesions. Cox regression analyzed factors predictive for overall survival. RESULTS: The median age at diagnosis was 52 years. Over time, patients underwent a median of 3 courses of SRS (range: 3-8) to a total of 765 different brain metastases. The 6-month risk of distant intracranial recurrence after the first SRS treatment was 64% (95% confidence interval: 52%-77%). Overall survival was 40% (95% confidence interval: 28%-53%) at 24 months. Only 24 patients (41%) had a decline in their Karnofsky Performance Status ≤70 at last office visit. Quality of life was preserved among 77% of patients at 12 months, with 45% experiencing clinically significant improvement during clinical follow-up. Radiation necrosis developed in 10 patients (17%). On multivariate analysis, gender (males, Hazard Ratio [HR]: 2.0, P < .05), Karnofsky Performance Status ≤80 (HR 3.2, P < .001), extracranial metastases (HR: 3.6, P < .001), and a distant intracranial recurrence ≤3 months from initial to repeat SRS (HR: 3.8, P < .001) were associated with a poorer survival. CONCLUSION: In selected patients, performing ≥3 SRS courses controls intracranial disease. Patients may need salvage SRS for distant intracranial relapse, but focal retreatments are associated with modest toxicity, do not appear to negatively affect a patient's performance status, and help preserve quality of life.
BACKGROUND: Although patients with brain metastasis are treated with primary stereotactic radiosurgery (SRS), the use of salvage therapies and their consequence remains understudied. OBJECTIVE: To study the intracranial recurrence patterns and salvage therapies for patients who underwent multiple SRS courses. METHODS: A retrospective review was performed of 59 patients with brain metastases who underwent ≥3 SRS courses for new lesions. Cox regression analyzed factors predictive for overall survival. RESULTS: The median age at diagnosis was 52 years. Over time, patients underwent a median of 3 courses of SRS (range: 3-8) to a total of 765 different brain metastases. The 6-month risk of distant intracranial recurrence after the first SRS treatment was 64% (95% confidence interval: 52%-77%). Overall survival was 40% (95% confidence interval: 28%-53%) at 24 months. Only 24 patients (41%) had a decline in their Karnofsky Performance Status ≤70 at last office visit. Quality of life was preserved among 77% of patients at 12 months, with 45% experiencing clinically significant improvement during clinical follow-up. Radiation necrosis developed in 10 patients (17%). On multivariate analysis, gender (males, Hazard Ratio [HR]: 2.0, P < .05), Karnofsky Performance Status ≤80 (HR 3.2, P < .001), extracranial metastases (HR: 3.6, P < .001), and a distant intracranial recurrence ≤3 months from initial to repeat SRS (HR: 3.8, P < .001) were associated with a poorer survival. CONCLUSION: In selected patients, performing ≥3 SRS courses controls intracranial disease. Patients may need salvage SRS for distant intracranial relapse, but focal retreatments are associated with modest toxicity, do not appear to negatively affect a patient's performance status, and help preserve quality of life.
Authors: Stella K Yoo; Ben A Strickland; Gabriel Zada; Shelly X Bian; Adam Garsa; Jason C Ye; Cheng Yu; Martin H Weiss; Bozena B Wrobel; Steven Giannotta; Eric L Chang Journal: J Neurol Surg B Skull Base Date: 2020-01-14
Authors: Joseph M Kim; Jacob A Miller; Rupesh Kotecha; Roy Xiao; Aditya Juloori; Matthew C Ward; Manmeet S Ahluwalia; Alireza M Mohammadi; David M Peereboom; Erin S Murphy; John H Suh; Gene H Barnett; Michael A Vogelbaum; Lilyana Angelov; Glen H Stevens; Samuel T Chao Journal: J Neurooncol Date: 2017-04-22 Impact factor: 4.130
Authors: John H Suh; Rupesh Kotecha; Samuel T Chao; Manmeet S Ahluwalia; Arjun Sahgal; Eric L Chang Journal: Nat Rev Clin Oncol Date: 2020-02-20 Impact factor: 66.675
Authors: Nayan Lamba; Ivo S Muskens; Aislyn C DiRisio; Louise Meijer; Vanessa Briceno; Heba Edrees; Bilal Aslam; Sadia Minhas; Joost J C Verhoeff; Catharina E Kleynen; Timothy R Smith; Rania A Mekary; Marike L Broekman Journal: Radiat Oncol Date: 2017-06-24 Impact factor: 3.481
Authors: Jianling Yuan; Richard Lee; Kathryn Ellen Dusenbery; Chung K Lee; Damien C Mathew; Paul Wayne Sperduto; Yoichi Watanabe Journal: Front Oncol Date: 2018-03-13 Impact factor: 6.244