E Hamel-Perreault1, D Mathieu1, L Masson-Cote1. 1. Centre hospitalier universitaire de Sherbrooke, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, QC.
Abstract
Background: Stereotactic radiosurgery (srs) for patients with 5 or more brain metastases (bmets) is a matter of debate. We report our results with that approach and the factors influencing outcome. Methods: In the 103 patients who underwent srs for the treatment of 5 or more bmets, primary histology was non-small-cell lung cancer (57% of patients). All patients were grouped by Karnofsky performance status and recursive partitioning analysis (rpa) classification. In our cohort, 72% of patients had uncontrolled extracranial disease, and 28% had stable or responding systemic disease. Previous irradiation for 1-4 bmets had been given to 56 patients (54%). The mean number of treated bmets was 7 (range: 5-19), and the median cumulative bmets volume was 2 cm3 (range: 0.06-28 cm3). Results: Multivariate analyses showed that stable extracranial disease (p < 0.001) and rpa (p = 0.022) were independent prognostic factors for overall survival (os). Moreover, a cumulative treated bmets volume of less than 6 cm3 (adjusted hazard ratio: 2.54; p = 0.006; 95% confidence interval: 1.30 to 4.99) was associated with better os. The total number of bmets had no effect on survival (p = 0.206). No variable was found to be predictive of local control. The rpa was significant (p = 0.027) in terms of distant recurrence. Conclusions: Our study suggests that srs is a reasonable option for the management of patients with 5 or more bmets, especially with a cumulative treatment volume of less than 6 cm3.
Background: Stereotactic radiosurgery (srs) for patients with 5 or more brain metastases (bmets) is a matter of debate. We report our results with that approach and the factors influencing outcome. Methods: In the 103 patients who underwent srs for the treatment of 5 or more bmets, primary histology was non-small-cell lung cancer (57% of patients). All patients were grouped by Karnofsky performance status and recursive partitioning analysis (rpa) classification. In our cohort, 72% of patients had uncontrolled extracranial disease, and 28% had stable or responding systemic disease. Previous irradiation for 1-4 bmets had been given to 56 patients (54%). The mean number of treated bmets was 7 (range: 5-19), and the median cumulative bmets volume was 2 cm3 (range: 0.06-28 cm3). Results: Multivariate analyses showed that stable extracranial disease (p < 0.001) and rpa (p = 0.022) were independent prognostic factors for overall survival (os). Moreover, a cumulative treated bmets volume of less than 6 cm3 (adjusted hazard ratio: 2.54; p = 0.006; 95% confidence interval: 1.30 to 4.99) was associated with better os. The total number of bmets had no effect on survival (p = 0.206). No variable was found to be predictive of local control. The rpa was significant (p = 0.027) in terms of distant recurrence. Conclusions: Our study suggests that srs is a reasonable option for the management of patients with 5 or more bmets, especially with a cumulative treatment volume of less than 6 cm3.
Authors: Il Kyoon Kim; Robert M Starke; Donald A McRae; Nadim M Nasr; Anthony Caputy; George D Cernica; Robert L Hong; Jonathan H Sherman Journal: J Clin Neurosci Date: 2017-01-11 Impact factor: 1.961
Authors: Nancy U Lin; Eudocia Q Lee; Hidefumi Aoyama; Igor J Barani; Daniel P Barboriak; Brigitta G Baumert; Martin Bendszus; Paul D Brown; D Ross Camidge; Susan M Chang; Janet Dancey; Elisabeth G E de Vries; Laurie E Gaspar; Gordon J Harris; F Stephen Hodi; Steven N Kalkanis; Mark E Linskey; David R Macdonald; Kim Margolin; Minesh P Mehta; David Schiff; Riccardo Soffietti; John H Suh; Martin J van den Bent; Michael A Vogelbaum; Patrick Y Wen Journal: Lancet Oncol Date: 2015-05-27 Impact factor: 41.316
Authors: L Gaspar; C Scott; M Rotman; S Asbell; T Phillips; T Wasserman; W G McKenna; R Byhardt Journal: Int J Radiat Oncol Biol Phys Date: 1997-03-01 Impact factor: 7.038
Authors: Paul W Sperduto; Samuel T Chao; Penny K Sneed; Xianghua Luo; John Suh; David Roberge; Amit Bhatt; Ashley W Jensen; Paul D Brown; Helen Shih; John Kirkpatrick; Amanda Schwer; Laurie E Gaspar; John B Fiveash; Veronica Chiang; Jonathan Knisely; Christina Maria Sperduto; Minesh Mehta Journal: Int J Radiat Oncol Biol Phys Date: 2009-11-26 Impact factor: 7.038
Authors: Gabriel N Hortobagyi; Salomon M Stemmer; Howard A Burris; Yoon-Sim Yap; Gabe S Sonke; Shani Paluch-Shimon; Mario Campone; Kimberly L Blackwell; Fabrice André; Eric P Winer; Wolfgang Janni; Sunil Verma; Pierfranco Conte; Carlos L Arteaga; David A Cameron; Katarina Petrakova; Lowell L Hart; Cristian Villanueva; Arlene Chan; Erik Jakobsen; Arnd Nusch; Olga Burdaeva; Eva-Maria Grischke; Emilio Alba; Erik Wist; Norbert Marschner; Anne M Favret; Denise Yardley; Thomas Bachelot; Ling-Ming Tseng; Sibel Blau; Fengjuan Xuan; Farida Souami; Michelle Miller; Caroline Germa; Samit Hirawat; Joyce O'Shaughnessy Journal: N Engl J Med Date: 2016-10-07 Impact factor: 91.245
Authors: Eric Ojerholm; John Y K Lee; James Kolker; Robert Lustig; Jay F Dorsey; Michelle Alonso-Basanta Journal: Cancer Med Date: 2014-02-10 Impact factor: 4.452
Authors: P B Chapman; C Robert; J Larkin; J B Haanen; A Ribas; D Hogg; O Hamid; P A Ascierto; A Testori; P C Lorigan; R Dummer; J A Sosman; K T Flaherty; I Chang; S Coleman; I Caro; A Hauschild; G A McArthur Journal: Ann Oncol Date: 2017-10-01 Impact factor: 32.976
Authors: Anthony L Asher; Mohammed Ali Alvi; Mohamad Bydon; Nader Pouratian; Ronald E Warnick; James McInerney; Inga S Grills; Jason Sheehan Journal: J Neurooncol Date: 2021-01-22 Impact factor: 4.130
Authors: Michael T Milano; Veronica L S Chiang; Scott G Soltys; Tony J C Wang; Simon S Lo; Alexandria Brackett; Seema Nagpal; Samuel Chao; Amit K Garg; Siavash Jabbari; Lia M Halasz; Melanie Hayden Gephart; Jonathan P S Knisely; Arjun Sahgal; Eric L Chang Journal: Neuro Oncol Date: 2020-12-18 Impact factor: 12.300