Ryan T Hughes1, Paul J Black1, Brandi R Page1, John T Lucas1, Shadi A Qasem2, Kounosuke Watabe3, Jimmy Ruiz4, Adrian W Laxton5, Stephen B Tatter5, Waldemar Debinski6, Michael D Chan1. 1. Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA. 2. Department of Pathology, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA. 3. Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA. 4. Department of Internal Medicine-Hematology/Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA. 5. Department of Neurosurgery, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA. 6. Brain Tumor Center of Excellence, Wake Forest Baptist Medical Center, Winston-Salem, NC 27157, USA.
Abstract
PURPOSE: We investigate clinical, pathologic, and treatment paradigm-related factors affecting local control of brain metastases after stereotactic radiosurgery (SRS) with or without whole brain radiotherapy (WBRT). METHODS AND MATERIALS: Patients with brain metastases treated with SRS alone, before or after WBRT were considered to determine predictors of local failure (LF), time to failure and survival. RESULTS: Among 137 patients, 411 brain metastases were analyzed. 23% of patients received SRS alone, 51% received WBRT prior to SRS, and 26% received SRS followed by WBRT. LF occurred in 125 metastases: 63% after SRS alone, 20% after WBRT then SRS, and 22% after SRS then WBRT. Median time to local failure was significantly less after SRS alone compared to WBRT then SRS (12.1 v. 22.7 months, p=0.003). Tumor volume was significantly associated with LF (HR:5.2, p<0.001, 95% CI:3.4-7.8). CONCLUSIONS: WBRT+SRS results in reduced LF. Local control was not significantly different after SRS as salvage therapy versus upfront SRS.
PURPOSE: We investigate clinical, pathologic, and treatment paradigm-related factors affecting local control of brain metastases after stereotactic radiosurgery (SRS) with or without whole brain radiotherapy (WBRT). METHODS AND MATERIALS: Patients with brain metastases treated with SRS alone, before or after WBRT were considered to determine predictors of local failure (LF), time to failure and survival. RESULTS: Among 137 patients, 411 brain metastases were analyzed. 23% of patients received SRS alone, 51% received WBRT prior to SRS, and 26% received SRS followed by WBRT. LF occurred in 125 metastases: 63% after SRS alone, 20% after WBRT then SRS, and 22% after SRS then WBRT. Median time to local failure was significantly less after SRS alone compared to WBRT then SRS (12.1 v. 22.7 months, p=0.003). Tumor volume was significantly associated with LF (HR:5.2, p<0.001, 95% CI:3.4-7.8). CONCLUSIONS: WBRT+SRS results in reduced LF. Local control was not significantly different after SRS as salvage therapy versus upfront SRS.
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