Initial SRS for Patients With 5 to 15 Brain Metastases: Results of a Multi-Institutional Experience
Several studies evaluating stereotactic radiosurgery (SRS) for patients with >4 brain metastases (BM) demonstrated similar outcomes after treatment of 1, 2 to 4, and 5 to 15 BM; others found clinically significant survival decrements in the latter group. In this review of 8 academic centers, we c...
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| Veröffentlicht in: | International journal of radiation oncology, biology, physics biology, physics, 2019-08, Vol.104 (5), p.1091-1098 |
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| creator | Hughes, Ryan T. Masters, Adrianna H. McTyre, Emory R. Farris, Michael K. Chung, Caroline Page, Brandi R. Kleinberg, Lawrence R. Hepel, Jaroslaw Contessa, Joseph N. Chiang, Veronica Ruiz, Jimmy Watabe, Kounosuke Su, Jing Fiveash, John B. Braunstein, Steve Chao, Samuel Attia, Albert Ayala-Peacock, Diandra N. Chan, Michael D. |
| description | Several studies evaluating stereotactic radiosurgery (SRS) for patients with >4 brain metastases (BM) demonstrated similar outcomes after treatment of 1, 2 to 4, and 5 to 15 BM; others found clinically significant survival decrements in the latter group. In this review of 8 academic centers, we compared outcomes of patients undergoing initial SRS for 1, 2 to 4, and 5 to 15 BM.
A total of 2089 patients treated with initial SRS for BM were included. Overall survival (OS) was estimated using the Kaplan-Meier method and compared using the log-rank test. Patient and disease characteristics were evaluated for association with OS and cumulative incidence of distant brain failure (DBF) using stepwise multivariable Cox proportional hazards and competing risk regression modeling.
In this series, 989 (47%) patients had 1 metastasis, 882 (42%) had 2 to 4 metastases, and 212 (10%) had 5 to 15 metastases treated. Median OS for the 1, 2 to 4, and 5 to 15 BM groups was 14.6, 9.5, and 7.5 months, respectively (log-rank P |
| doi_str_mv | 10.1016/j.ijrobp.2019.03.052 |
| format | Article |
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A total of 2089 patients treated with initial SRS for BM were included. Overall survival (OS) was estimated using the Kaplan-Meier method and compared using the log-rank test. Patient and disease characteristics were evaluated for association with OS and cumulative incidence of distant brain failure (DBF) using stepwise multivariable Cox proportional hazards and competing risk regression modeling.
In this series, 989 (47%) patients had 1 metastasis, 882 (42%) had 2 to 4 metastases, and 212 (10%) had 5 to 15 metastases treated. Median OS for the 1, 2 to 4, and 5 to 15 BM groups was 14.6, 9.5, and 7.5 months, respectively (log-rank P < .01). Univariate and multivariable analyses revealed no difference in survival between 2 to 4 and 5 to 15 BM. DBF at 1 year was 30%, 41%, and 50%, respectively (Gray's P < .01). Two-year cumulative incidence of salvage SRS decreased with increasing number of BM (1: 21% vs 2-4: 19% vs 5-15: 13%; P < .01), but no difference in salvage whole brain radiation therapy was observed (1: 12% vs 2-4: 15% vs 5-15: 16%, P = .10). At the time of DBF, median brain metastasis velocity was 3.9, 6.1, and 11.7 new metastases per year in the 1, 2 to 4, and 5 to 15 BM groups, respectively (P < .01).
Patients treated with initial SRS for 5 to 15 BM experienced survival similar to that in patients with 2 to 4 BM. Lower rates of salvage SRS were observed in the 5 to 15 BM group, with no difference in rates of salvage whole brain radiation therapy.</description><identifier>ISSN: 0360-3016</identifier><identifier>EISSN: 1879-355X</identifier><identifier>DOI: 10.1016/j.ijrobp.2019.03.052</identifier><identifier>PMID: 30959122</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Aged ; Brain Neoplasms - mortality ; Brain Neoplasms - pathology ; Brain Neoplasms - radiotherapy ; Brain Neoplasms - secondary ; Cranial Irradiation - adverse effects ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Proportional Hazards Models ; Radiosurgery - methods ; Radiosurgery - mortality ; Salvage Therapy - statistics & numerical data ; Survival Analysis ; Treatment Outcome</subject><ispartof>International journal of radiation oncology, biology, physics, 2019-08, Vol.104 (5), p.1091-1098</ispartof><rights>2019 Elsevier Inc.</rights><rights>Copyright © 2019 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c362t-cfae832ba3fd64fe85b21b4545360f2053cd42575cc988efdf5cc2cf49cebef73</citedby><cites>FETCH-LOGICAL-c362t-cfae832ba3fd64fe85b21b4545360f2053cd42575cc988efdf5cc2cf49cebef73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.ijrobp.2019.03.052$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30959122$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hughes, Ryan T.</creatorcontrib><creatorcontrib>Masters, Adrianna H.</creatorcontrib><creatorcontrib>McTyre, Emory R.</creatorcontrib><creatorcontrib>Farris, Michael K.</creatorcontrib><creatorcontrib>Chung, Caroline</creatorcontrib><creatorcontrib>Page, Brandi R.</creatorcontrib><creatorcontrib>Kleinberg, Lawrence R.</creatorcontrib><creatorcontrib>Hepel, Jaroslaw</creatorcontrib><creatorcontrib>Contessa, Joseph N.</creatorcontrib><creatorcontrib>Chiang, Veronica</creatorcontrib><creatorcontrib>Ruiz, Jimmy</creatorcontrib><creatorcontrib>Watabe, Kounosuke</creatorcontrib><creatorcontrib>Su, Jing</creatorcontrib><creatorcontrib>Fiveash, John B.</creatorcontrib><creatorcontrib>Braunstein, Steve</creatorcontrib><creatorcontrib>Chao, Samuel</creatorcontrib><creatorcontrib>Attia, Albert</creatorcontrib><creatorcontrib>Ayala-Peacock, Diandra N.</creatorcontrib><creatorcontrib>Chan, Michael D.</creatorcontrib><title>Initial SRS for Patients With 5 to 15 Brain Metastases: Results of a Multi-Institutional Experience</title><title>International journal of radiation oncology, biology, physics</title><addtitle>Int J Radiat Oncol Biol Phys</addtitle><description>Several studies evaluating stereotactic radiosurgery (SRS) for patients with >4 brain metastases (BM) demonstrated similar outcomes after treatment of 1, 2 to 4, and 5 to 15 BM; others found clinically significant survival decrements in the latter group. In this review of 8 academic centers, we compared outcomes of patients undergoing initial SRS for 1, 2 to 4, and 5 to 15 BM.
A total of 2089 patients treated with initial SRS for BM were included. Overall survival (OS) was estimated using the Kaplan-Meier method and compared using the log-rank test. Patient and disease characteristics were evaluated for association with OS and cumulative incidence of distant brain failure (DBF) using stepwise multivariable Cox proportional hazards and competing risk regression modeling.
In this series, 989 (47%) patients had 1 metastasis, 882 (42%) had 2 to 4 metastases, and 212 (10%) had 5 to 15 metastases treated. Median OS for the 1, 2 to 4, and 5 to 15 BM groups was 14.6, 9.5, and 7.5 months, respectively (log-rank P < .01). Univariate and multivariable analyses revealed no difference in survival between 2 to 4 and 5 to 15 BM. DBF at 1 year was 30%, 41%, and 50%, respectively (Gray's P < .01). Two-year cumulative incidence of salvage SRS decreased with increasing number of BM (1: 21% vs 2-4: 19% vs 5-15: 13%; P < .01), but no difference in salvage whole brain radiation therapy was observed (1: 12% vs 2-4: 15% vs 5-15: 16%, P = .10). At the time of DBF, median brain metastasis velocity was 3.9, 6.1, and 11.7 new metastases per year in the 1, 2 to 4, and 5 to 15 BM groups, respectively (P < .01).
Patients treated with initial SRS for 5 to 15 BM experienced survival similar to that in patients with 2 to 4 BM. Lower rates of salvage SRS were observed in the 5 to 15 BM group, with no difference in rates of salvage whole brain radiation therapy.</description><subject>Aged</subject><subject>Brain Neoplasms - mortality</subject><subject>Brain Neoplasms - pathology</subject><subject>Brain Neoplasms - radiotherapy</subject><subject>Brain Neoplasms - secondary</subject><subject>Cranial Irradiation - adverse effects</subject><subject>Female</subject><subject>Humans</subject><subject>Kaplan-Meier Estimate</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Proportional Hazards Models</subject><subject>Radiosurgery - methods</subject><subject>Radiosurgery - mortality</subject><subject>Salvage Therapy - statistics & numerical data</subject><subject>Survival Analysis</subject><subject>Treatment Outcome</subject><issn>0360-3016</issn><issn>1879-355X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE1LxDAQhoMoun78A5EcvbTmo-m2HgQVPxYUZVfRW0jTCWbpNmuSiv57o6sehYGZwzPvMA9C-5TklNDyaJ7buXfNMmeE1jnhORFsDY1oNa4zLsTzOhoRXpKMJ3gLbYcwJ4RQOi420RYntagpYyOkJ72NVnV4Np1h4zy-V9FCHwN-svEFCxwdpgKfeWV7fAtRhVQQjvEUwtAlzBms8G0abTbpQ7RxiNb1KfDifQk-RWnYRRtGdQH2fvoOery8eDi_zm7uribnpzeZ5iWLmTYKKs4axU1bFgYq0TDaFKIQ6Q3DiOC6LZgYC63rqgLTmjQxbYpaQwNmzHfQ4Sp36d3rACHKhQ0auk714IYgGSMl47QkRUKLFaq9C8GDkUtvF8p_SErkl145lyu98kuvJFwmvWnt4OfC0Cyg_Vv69ZmAkxUA6c83C14G_e2gtR50lK2z_1_4BOOmjeM</recordid><startdate>20190801</startdate><enddate>20190801</enddate><creator>Hughes, Ryan T.</creator><creator>Masters, Adrianna H.</creator><creator>McTyre, Emory R.</creator><creator>Farris, Michael K.</creator><creator>Chung, Caroline</creator><creator>Page, Brandi R.</creator><creator>Kleinberg, Lawrence R.</creator><creator>Hepel, Jaroslaw</creator><creator>Contessa, Joseph N.</creator><creator>Chiang, Veronica</creator><creator>Ruiz, Jimmy</creator><creator>Watabe, Kounosuke</creator><creator>Su, Jing</creator><creator>Fiveash, John B.</creator><creator>Braunstein, Steve</creator><creator>Chao, Samuel</creator><creator>Attia, Albert</creator><creator>Ayala-Peacock, Diandra N.</creator><creator>Chan, Michael D.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20190801</creationdate><title>Initial SRS for Patients With 5 to 15 Brain Metastases: Results of a Multi-Institutional Experience</title><author>Hughes, Ryan T. ; Masters, Adrianna H. ; McTyre, Emory R. ; Farris, Michael K. ; Chung, Caroline ; Page, Brandi R. ; Kleinberg, Lawrence R. ; Hepel, Jaroslaw ; Contessa, Joseph N. ; Chiang, Veronica ; Ruiz, Jimmy ; Watabe, Kounosuke ; Su, Jing ; Fiveash, John B. ; Braunstein, Steve ; Chao, Samuel ; Attia, Albert ; Ayala-Peacock, Diandra N. ; Chan, Michael D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c362t-cfae832ba3fd64fe85b21b4545360f2053cd42575cc988efdf5cc2cf49cebef73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Brain Neoplasms - mortality</topic><topic>Brain Neoplasms - pathology</topic><topic>Brain Neoplasms - radiotherapy</topic><topic>Brain Neoplasms - secondary</topic><topic>Cranial Irradiation - adverse effects</topic><topic>Female</topic><topic>Humans</topic><topic>Kaplan-Meier Estimate</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Proportional Hazards Models</topic><topic>Radiosurgery - methods</topic><topic>Radiosurgery - mortality</topic><topic>Salvage Therapy - statistics & numerical data</topic><topic>Survival Analysis</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hughes, Ryan T.</creatorcontrib><creatorcontrib>Masters, Adrianna H.</creatorcontrib><creatorcontrib>McTyre, Emory R.</creatorcontrib><creatorcontrib>Farris, Michael K.</creatorcontrib><creatorcontrib>Chung, Caroline</creatorcontrib><creatorcontrib>Page, Brandi R.</creatorcontrib><creatorcontrib>Kleinberg, Lawrence R.</creatorcontrib><creatorcontrib>Hepel, Jaroslaw</creatorcontrib><creatorcontrib>Contessa, Joseph N.</creatorcontrib><creatorcontrib>Chiang, Veronica</creatorcontrib><creatorcontrib>Ruiz, Jimmy</creatorcontrib><creatorcontrib>Watabe, Kounosuke</creatorcontrib><creatorcontrib>Su, Jing</creatorcontrib><creatorcontrib>Fiveash, John B.</creatorcontrib><creatorcontrib>Braunstein, Steve</creatorcontrib><creatorcontrib>Chao, Samuel</creatorcontrib><creatorcontrib>Attia, Albert</creatorcontrib><creatorcontrib>Ayala-Peacock, Diandra N.</creatorcontrib><creatorcontrib>Chan, Michael D.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>International journal of radiation oncology, biology, physics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hughes, Ryan T.</au><au>Masters, Adrianna H.</au><au>McTyre, Emory R.</au><au>Farris, Michael K.</au><au>Chung, Caroline</au><au>Page, Brandi R.</au><au>Kleinberg, Lawrence R.</au><au>Hepel, Jaroslaw</au><au>Contessa, Joseph N.</au><au>Chiang, Veronica</au><au>Ruiz, Jimmy</au><au>Watabe, Kounosuke</au><au>Su, Jing</au><au>Fiveash, John B.</au><au>Braunstein, Steve</au><au>Chao, Samuel</au><au>Attia, Albert</au><au>Ayala-Peacock, Diandra N.</au><au>Chan, Michael D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Initial SRS for Patients With 5 to 15 Brain Metastases: Results of a Multi-Institutional Experience</atitle><jtitle>International journal of radiation oncology, biology, physics</jtitle><addtitle>Int J Radiat Oncol Biol Phys</addtitle><date>2019-08-01</date><risdate>2019</risdate><volume>104</volume><issue>5</issue><spage>1091</spage><epage>1098</epage><pages>1091-1098</pages><issn>0360-3016</issn><eissn>1879-355X</eissn><abstract>Several studies evaluating stereotactic radiosurgery (SRS) for patients with >4 brain metastases (BM) demonstrated similar outcomes after treatment of 1, 2 to 4, and 5 to 15 BM; others found clinically significant survival decrements in the latter group. In this review of 8 academic centers, we compared outcomes of patients undergoing initial SRS for 1, 2 to 4, and 5 to 15 BM.
A total of 2089 patients treated with initial SRS for BM were included. Overall survival (OS) was estimated using the Kaplan-Meier method and compared using the log-rank test. Patient and disease characteristics were evaluated for association with OS and cumulative incidence of distant brain failure (DBF) using stepwise multivariable Cox proportional hazards and competing risk regression modeling.
In this series, 989 (47%) patients had 1 metastasis, 882 (42%) had 2 to 4 metastases, and 212 (10%) had 5 to 15 metastases treated. Median OS for the 1, 2 to 4, and 5 to 15 BM groups was 14.6, 9.5, and 7.5 months, respectively (log-rank P < .01). Univariate and multivariable analyses revealed no difference in survival between 2 to 4 and 5 to 15 BM. DBF at 1 year was 30%, 41%, and 50%, respectively (Gray's P < .01). Two-year cumulative incidence of salvage SRS decreased with increasing number of BM (1: 21% vs 2-4: 19% vs 5-15: 13%; P < .01), but no difference in salvage whole brain radiation therapy was observed (1: 12% vs 2-4: 15% vs 5-15: 16%, P = .10). At the time of DBF, median brain metastasis velocity was 3.9, 6.1, and 11.7 new metastases per year in the 1, 2 to 4, and 5 to 15 BM groups, respectively (P < .01).
Patients treated with initial SRS for 5 to 15 BM experienced survival similar to that in patients with 2 to 4 BM. Lower rates of salvage SRS were observed in the 5 to 15 BM group, with no difference in rates of salvage whole brain radiation therapy.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>30959122</pmid><doi>10.1016/j.ijrobp.2019.03.052</doi><tpages>8</tpages></addata></record> |
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| subjects | Aged Brain Neoplasms - mortality Brain Neoplasms - pathology Brain Neoplasms - radiotherapy Brain Neoplasms - secondary Cranial Irradiation - adverse effects Female Humans Kaplan-Meier Estimate Male Middle Aged Proportional Hazards Models Radiosurgery - methods Radiosurgery - mortality Salvage Therapy - statistics & numerical data Survival Analysis Treatment Outcome |
| title | Initial SRS for Patients With 5 to 15 Brain Metastases: Results of a Multi-Institutional Experience |
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