Stereotactic radiosurgery for patients with extensive brain metastases across the disease course.

IF 3.1 2区医学 Q2 CLINICAL NEUROLOGY

Journal of Neuro-Oncology Pub Date : 2025-10-16 DOI:10.1007/s11060-025-05256-x

Tina Vaziri, I-Chia Liu, Chetan Bettegowda, Victoria Croog, Christopher Jackson, David Kamson, Lawrence Kleinberg, Carmen Kut, Brandi Page, Debraj Mukherjee, Jordan Rincon-Torroella, Risheng Xu, Kristin J Redmond

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引用次数: 0

Abstract

Purpose: Stereotactic radiosurgery (SRS) is the standard of care for patients with limited brain metastases (BM). As systemic therapies prolong survival in metastatic disease, the role of SRS in patients with high intracranial disease burden remains undefined.

Methods: Ninety patients with ≥15 SRS-treated BMs throughout their disease course between 2010 and 2023 were retrospectively reviewed. Outcomes-including overall survival (OS), freedom from whole-brain radiotherapy (FFW), intracranial control (IC), radiation necrosis (RN), and cumulative brain dose-were analyzed. Outcomes were estimated using the Kaplan-Meier method or Fine-Gray model. Univariable and multivariable regression identified prognostic factors.

Results: The median number of BMs treated was 18 (IQR, 16-23) over a median of two SRS courses (IQR, 2-3). Primary tumor sites were lung (47.3%) and breast (22.6%). At initial SRS, 84.9% had ECOG ≤1/KPS > 70, and 33% had neurologic symptoms. With median follow-up of 15 months (range, 0-118), RN occurred in 8.9%; 13.3% developed leptomeningeal disease (median onset 12 months) with a higher risk observed in breast cancer (OR 4.20, 95% CI 1.19-14.87, p = 0.026). The mean cumulative whole-brain dose across all SRS courses was 5.3 Gy. One-year FFW was 75.1% and 68.8% did not undergo WBRT. Median OS was 17 months (95% CI 9.46-24.54), with 1-year OS of 64%.

Conclusions: SRS is safe and feasible for patients with a high BM burden, offering potential delay and avoidance of WBRT. Prospective, multi-institutional studies are warranted to validate these findings and further define the role of SRS in this population.

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立体定向放射治疗在整个病程中广泛脑转移的患者。

目的：立体定向放射手术（SRS）是有限脑转移（BM）患者的标准治疗方法。由于全身治疗延长了转移性疾病的生存期，SRS在颅内疾病负担高的患者中的作用仍不明确。方法：回顾性分析2010年至2023年间90例≥15例srs治疗的脑转移患者的整个病程。结果包括总生存期（OS）、免于全脑放疗（FFW）、颅内控制（IC）、放射性坏死（RN）和脑累积剂量。使用Kaplan-Meier方法或Fine-Gray模型估计结果。单变量和多变量回归确定了预后因素。结果：治疗的脑转移瘤中位数为18例（IQR， 16-23例），中位数为2个SRS疗程（IQR, 2-3）。原发肿瘤部位为肺（47.3%）和乳腺（22.6%）。初始SRS时，84.9%的患者ECOG≤1/KPS bb70, 33%的患者有神经系统症状。中位随访15个月（范围0-118），RN发生率为8.9%；13.3%的患者发生了轻脑膜疾病（中位发病12个月），其中乳腺癌的风险更高（OR 4.20, 95% CI 1.19-14.87, p = 0.026）。所有SRS疗程的平均全脑累积剂量为5.3 Gy。一年FFW为75.1%，68.8%未接受WBRT。中位生存期为17个月（95% CI 9.46-24.54）， 1年生存期为64%。结论：对于脑转移负担高的患者，SRS是安全可行的，可以延迟和避免WBRT的发生。有必要进行前瞻性、多机构的研究来验证这些发现，并进一步确定SRS在该人群中的作用。

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

Journal of Neuro-Oncology 医学-临床神经学

CiteScore

6.60

自引率

7.70%

发文量

277

审稿时长

3.3 months

期刊介绍： The Journal of Neuro-Oncology is a multi-disciplinary journal encompassing basic, applied, and clinical investigations in all research areas as they relate to cancer and the central nervous system. It provides a single forum for communication among neurologists, neurosurgeons, radiotherapists, medical oncologists, neuropathologists, neurodiagnosticians, and laboratory-based oncologists conducting relevant research. The Journal of Neuro-Oncology does not seek to isolate the field, but rather to focus the efforts of many disciplines in one publication through a format which pulls together these diverse interests. More than any other field of oncology, cancer of the central nervous system requires multi-disciplinary approaches. To alleviate having to scan dozens of journals of cell biology, pathology, laboratory and clinical endeavours, JNO is a periodical in which current, high-quality, relevant research in all aspects of neuro-oncology may be found.