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Stereotactic radiosurgery in brain metastasis: treatment outcomes and patterns of failure

Published online by Cambridge University Press:  02 March 2023

Menekse Turna Open the ORCID record for Menekse Turna [Opens in a new window] ,
Rashad Rzazade ,
Esra Küçükmorkoç ,
Mehmet Doğu Canoğlu ,
Nadir Küçük  and
Hale Başak Çağlar
Menekse Turna*
Affiliation:
Department of Radiation Oncology, Anadolu Medical Center, Gebze, Kocaeli, Turkey
Rashad Rzazade
Affiliation:
Department of Radiation Oncology, Anadolu Medical Center, Gebze, Kocaeli, Turkey
Esra Küçükmorkoç
Affiliation:
Department of Radiation Oncology, Anadolu Medical Center, Gebze, Kocaeli, Turkey
Mehmet Doğu Canoğlu
Affiliation:
Department of Radiation Oncology, Anadolu Medical Center, Gebze, Kocaeli, Turkey
Nadir Küçük
Affiliation:
Department of Radiation Oncology, Anadolu Medical Center, Gebze, Kocaeli, Turkey
Hale Başak Çağlar
Affiliation:
Department of Radiation Oncology, Anadolu Medical Center, Gebze, Kocaeli, Turkey
*
Author for correspondence: Menekse Turna, Department of Radiation Oncology, Anadolu Medical Center, Gebze, Kocaeli, Turkey. E-mail: menekse.turna@gmail.com
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Abstract

Introduction:

Stereotactic radiosurgery (SRS) has become a preferred treatment in the initial management of brain metastases (BM). This study reported treatment outcomes and identified the patient, tumour, and treatment-related factors that predict failure, survival, and brain necrosis (BN).

Methods:

We retrospectively reviewed the electronic medical records of all BM patients treated with SRS. Patient, tumour characteristics and treatment details data were collected. All recurrences and BN were defined in the neurooncological tumour board.

Results:

From December 2016 to April 2020, 148 patients were analysed. The median follow-up was 14·8 months (range 6–51). At the time of analyses, 72·3% of the patients were alive. Presence of initial neurological deficit (HR; 2·71 (1·07–6·9); p = 0·036) and prior RT (HR; 2·55 (1·28–5·09); p = 0·008) is associated with worse overall survival. The local recurrence rate was 11·5 %. The distant brain metastasis rate was 53·4 %. Leptomeningeal metastasis was seen in 11 patients (7·4%). Symptomatic BN was seen in 19 patients (12·8 %). Bigger lesions (13 versus 23 mm diameter; p = 0·034) and cavity radiosurgery are associated with more BN (63·2 % versus 36·8%; p: 0·004).

Conclusions:

Distant BM is the leading cause of CNS recurrences and, salvage SRS is possible. Due to the increasing risk of developing BN routine metastasectomy should be made with caution.

Keywords

brain metastasisstereotactic radiosurgerystereotactic radiotherapy
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 22 , 2023 , e84
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Copyright
© The Author(s), 2023. Published by Cambridge University Press

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