Multi-institutional Outcomes after Stereotactic Radiosurgery for Gastrointestinal Brain Metastases

IF 2.7 Q3 ONCOLOGY

Advances in Radiation Oncology Pub Date : 2025-05-10 DOI:10.1016/j.adro.2025.101795

Jamiluddin J. Qazi MD , David J. Carpenter MD, MS , Jim Leng MD , Christina C. Huang MD, MS , Steven J. Chmura MD, PhD , Muzamil Arshad MD, PhD , Zachary J. Reitman MD, PhD , John P. Kirkpatrick MD, PhD , Julian C. Hong MD, MS , Scott R. Floyd MD, PhD , Trey C. Mullikin MD , Joseph K. Salama MD

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Abstract

Purpose

To compare outcomes between gastrointestinal and nongastrointestinal patients with brain metastases after radiosurgery.

Methods and Materials

Retrospective cohort study identifying patients completing an initial course of radiosurgery between January 2015 and December 2020, with follow-up data collected through November 2022. Multi-institutional, academic referral centers. The primary outcomes were overall survival and intracranial progression-free survival, calculated by the Kaplan–Meier method. Progression was defined as concern on postradiosurgery imaging for recurrence determined by clinical multidisciplinary consensus. Cox proportional hazard models were used to assess associations between outcomes and covariates.

Results

This study included 1281 nongastrointestinal patients and 102 gastrointestinal patients, of which 45.1% were colorectal, 33.3% esophageal, and the remaining 21.6% comprising other sites. Gastrointestinal patients were more likely to be younger (mean 59.1 vs 63.5 years, P = .001), male (56.9% vs 44.3%, P = 0.014), have received systemic therapy (73.5% vs 63.9%, P = .049), and have resection of brain metastases (45.1% vs 25.0%, P < .001) prior to radiosurgery. Median overall survival was lower for gastrointestinal patients at 5.4 months (95% CI, 3.8-7.7) versus nongastrointestinal patients at 10.6 months (95% CI, 9.3-11.6, P < 0.0001). In a multivariate model, gastrointestinal patients had worse overall survival compared to nongastrointestinal patients (hazard ratio, 1.92; P < .0001; 95% CI, 1.53-2.41). Median intracranial progression-free survival was lower for gastrointestinal patients at 6.2 months (95% CI, 4.0-9.6) versus nongastrointestinal patients at 12.3 months (95% CI, 10.8-13.9; P = 0.0002). In a multivariate model, gastrointestinal patients had worse intracranial progression-free survival compared to nongastrointestinal patients (hazard ratio, 1.60; 95% CI, 1.20-2.14; P = 0.0013). There were no significant differences between colorectal primary patient or esophageal primary patient outcomes compared to all other gastrointestinal primary patients.

Conclusions

Across a multi-institutional stereotactic radiosurgery cohort, brain metastases of gastrointestinal origin demonstrated inferior overall survival and intracranial progression-free survival to those of nongastrointestinal origin. These data may help inform treatment decisions and postradiosurgery surveillance.

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立体定向放射治疗胃肠道脑转移瘤后的多机构疗效

目的比较胃肠道和非胃肠道脑转移患者放疗后的预后。方法和材料回顾性队列研究确定2015年1月至2020年12月期间完成放射手术初始疗程的患者，随访数据收集至2022年11月。多机构学术转诊中心。主要结局是通过Kaplan-Meier方法计算的总生存期和颅内无进展生存期。进展被定义为术后影像学对复发的关注，由临床多学科共识决定。Cox比例风险模型用于评估结果和协变量之间的关联。结果本研究纳入1281例非胃肠道患者和102例胃肠道患者，其中45.1%为结直肠，33.3%为食管，其余21.6%为其他部位。胃肠道患者多为年轻（平均59.1岁vs 63.5岁，P = 0.001）、男性（56.9% vs 44.3%, P = 0.014）、接受过全身治疗（73.5% vs 63.9%, P = 0.049）、切除脑转移瘤(45.1% vs 25.0%, P <；.001)。胃肠道患者的中位总生存期为5.4个月（95% CI, 3.8-7.7），而非胃肠道患者的中位总生存期为10.6个月（95% CI, 9.3-11.6）。0.0001)。在一个多变量模型中，胃肠道患者的总生存率比非胃肠道患者差(风险比，1.92；P & lt;。;95% ci, 1.53-2.41)。胃肠道患者的中位颅内无进展生存期为6.2个月（95% CI, 4.0-9.6），而非胃肠道患者为12.3个月(95% CI, 10.8-13.9；P = 0.0002)。在一个多变量模型中，胃肠道患者的颅内无进展生存期比非胃肠道患者更差(风险比，1.60；95% ci, 1.20-2.14；P = 0.0013)。与所有其他胃肠道原发患者相比，结直肠原发患者或食管原发患者的预后无显著差异。结论：在一个多机构立体定向放射外科队列研究中，胃肠道源性脑转移瘤的总生存期和颅内无进展生存期低于非胃肠道源性脑转移瘤。这些数据可能有助于指导治疗决策和术后监测。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Advances in Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

4.60

自引率

4.30%

发文量

208

审稿时长

98 days

期刊介绍： The purpose of Advances is to provide information for clinicians who use radiation therapy by publishing: Clinical trial reports and reanalyses. Basic science original reports. Manuscripts examining health services research, comparative and cost effectiveness research, and systematic reviews. Case reports documenting unusual problems and solutions. High quality multi and single institutional series, as well as other novel retrospective hypothesis generating series. Timely critical reviews on important topics in radiation oncology, such as side effects. Articles reporting the natural history of disease and patterns of failure, particularly as they relate to treatment volume delineation. Articles on safety and quality in radiation therapy. Essays on clinical experience. Articles on practice transformation in radiation oncology, in particular: Aspects of health policy that may impact the future practice of radiation oncology. How information technology, such as data analytics and systems innovations, will change radiation oncology practice. Articles on imaging as they relate to radiation therapy treatment.