Comparative evaluation of outcomes amongst different radiosurgery management paradigms for patients with large brain metastasis

Introduction This study compares four management paradigms for large brain metastasis (LMB): fractionated SRS (FSRS), staged SRS (SSRS), resection and postoperative-FSRS (postop-FSRS) or preoperative-SRS (preop-SRS). Methods Patients with LBM (≥ 2 cm) between July 2017 and January 2022 at a single t...

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Veröffentlicht in:Journal of neuro-oncology 2024-08, Vol.169 (1), p.105-117
Hauptverfasser: Kutuk, Tugce, Zhang, Yanjia, Akdemir, Eyub Yasar, Yarlagadda, Sreenija, Tolakanahalli, Ranjini, Hall, Matthew D., La Rosa, Alonso, Wieczorek, DJay J., Lee, Yongsook C., Press, Robert H., Appel, Haley, McDermott, Michael W., Odia, Yazmin, Ahluwalia, Manmeet S., Gutierrez, Alonso N., Mehta, Minesh P., Kotecha, Rupesh
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container_end_page 117
container_issue 1
container_start_page 105
container_title Journal of neuro-oncology
container_volume 169
creator Kutuk, Tugce
Zhang, Yanjia
Akdemir, Eyub Yasar
Yarlagadda, Sreenija
Tolakanahalli, Ranjini
Hall, Matthew D.
La Rosa, Alonso
Wieczorek, DJay J.
Lee, Yongsook C.
Press, Robert H.
Appel, Haley
McDermott, Michael W.
Odia, Yazmin
Ahluwalia, Manmeet S.
Gutierrez, Alonso N.
Mehta, Minesh P.
Kotecha, Rupesh
description Introduction This study compares four management paradigms for large brain metastasis (LMB): fractionated SRS (FSRS), staged SRS (SSRS), resection and postoperative-FSRS (postop-FSRS) or preoperative-SRS (preop-SRS). Methods Patients with LBM (≥ 2 cm) between July 2017 and January 2022 at a single tertiary institution were evaluated. Primary endpoints were local failure (LF), radiation necrosis (RN), leptomeningeal disease (LMD), a composite of these variables, and distant intracranial failure (DIF). Gray’s test compared cumulative incidence, treating death as a competing risk with a random survival forests (RSF) machine-learning model also used to evaluate the data. Results 183 patients were treated to 234 LBMs: 31.6% for postop-FSRS, 28.2% for SSRS, 20.1% for FSRS, and 20.1% for preop-SRS. The overall 1-year composite endpoint rates were comparable (21 vs 20%) between nonoperative and operative strategies, but 1-year RN rate was 8 vs 4% ( p  = 0.012), 1-year overall survival (OS) was 48 vs. 69% ( p  = 0.001), and 1-year LMD rate was 5 vs 10% ( p  = 0.052). There were differences in the 1-year RN rates (7% FSRS, 3% postop-FSRS, 5% preop-SRS, 10% SSRS, p  = 0.037). With RSF analysis, the out-of-bag error rate for the composite endpoint was 47%, with identified top-risk factors including widespread extracranial disease, > 5 total lesions, and breast cancer histology. Conclusion This is the first study to conduct a head-to-head retrospective comparison of four SRS methods, addressing the lack of randomized data in LBM literature amongst treatment paradigms. Despite patient characteristic trends, no significant differences were found in LF, composite endpoint, and DIF rates between non-operative and operative approaches.
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Methods Patients with LBM (≥ 2 cm) between July 2017 and January 2022 at a single tertiary institution were evaluated. Primary endpoints were local failure (LF), radiation necrosis (RN), leptomeningeal disease (LMD), a composite of these variables, and distant intracranial failure (DIF). Gray’s test compared cumulative incidence, treating death as a competing risk with a random survival forests (RSF) machine-learning model also used to evaluate the data. Results 183 patients were treated to 234 LBMs: 31.6% for postop-FSRS, 28.2% for SSRS, 20.1% for FSRS, and 20.1% for preop-SRS. The overall 1-year composite endpoint rates were comparable (21 vs 20%) between nonoperative and operative strategies, but 1-year RN rate was 8 vs 4% ( p  = 0.012), 1-year overall survival (OS) was 48 vs. 69% ( p  = 0.001), and 1-year LMD rate was 5 vs 10% ( p  = 0.052). There were differences in the 1-year RN rates (7% FSRS, 3% postop-FSRS, 5% preop-SRS, 10% SSRS, p  = 0.037). With RSF analysis, the out-of-bag error rate for the composite endpoint was 47%, with identified top-risk factors including widespread extracranial disease, &gt; 5 total lesions, and breast cancer histology. Conclusion This is the first study to conduct a head-to-head retrospective comparison of four SRS methods, addressing the lack of randomized data in LBM literature amongst treatment paradigms. Despite patient characteristic trends, no significant differences were found in LF, composite endpoint, and DIF rates between non-operative and operative approaches.</description><identifier>ISSN: 0167-594X</identifier><identifier>ISSN: 1573-7373</identifier><identifier>EISSN: 1573-7373</identifier><identifier>DOI: 10.1007/s11060-024-04706-2</identifier><identifier>PMID: 38837019</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Adult ; Aged ; Brain cancer ; Brain Neoplasms - mortality ; Brain Neoplasms - radiotherapy ; Brain Neoplasms - secondary ; Brain Neoplasms - surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Medicine ; Medicine &amp; Public Health ; Meninges ; Metastases ; Metastasis ; Middle Aged ; Neurology ; Oncology ; Radiosurgery ; Radiosurgery - methods ; Retrospective Studies ; Risk factors ; Survival ; Survival Rate ; Treatment Outcome</subject><ispartof>Journal of neuro-oncology, 2024-08, Vol.169 (1), p.105-117</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c256t-7987f16739941d6e7a9893b1470540737387bbd1d9759edea5725481bd221e783</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11060-024-04706-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11060-024-04706-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/38837019$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kutuk, Tugce</creatorcontrib><creatorcontrib>Zhang, Yanjia</creatorcontrib><creatorcontrib>Akdemir, Eyub Yasar</creatorcontrib><creatorcontrib>Yarlagadda, Sreenija</creatorcontrib><creatorcontrib>Tolakanahalli, Ranjini</creatorcontrib><creatorcontrib>Hall, Matthew D.</creatorcontrib><creatorcontrib>La Rosa, Alonso</creatorcontrib><creatorcontrib>Wieczorek, DJay J.</creatorcontrib><creatorcontrib>Lee, Yongsook C.</creatorcontrib><creatorcontrib>Press, Robert H.</creatorcontrib><creatorcontrib>Appel, Haley</creatorcontrib><creatorcontrib>McDermott, Michael W.</creatorcontrib><creatorcontrib>Odia, Yazmin</creatorcontrib><creatorcontrib>Ahluwalia, Manmeet S.</creatorcontrib><creatorcontrib>Gutierrez, Alonso N.</creatorcontrib><creatorcontrib>Mehta, Minesh P.</creatorcontrib><creatorcontrib>Kotecha, Rupesh</creatorcontrib><title>Comparative evaluation of outcomes amongst different radiosurgery management paradigms for patients with large brain metastasis</title><title>Journal of neuro-oncology</title><addtitle>J Neurooncol</addtitle><addtitle>J Neurooncol</addtitle><description>Introduction This study compares four management paradigms for large brain metastasis (LMB): fractionated SRS (FSRS), staged SRS (SSRS), resection and postoperative-FSRS (postop-FSRS) or preoperative-SRS (preop-SRS). Methods Patients with LBM (≥ 2 cm) between July 2017 and January 2022 at a single tertiary institution were evaluated. Primary endpoints were local failure (LF), radiation necrosis (RN), leptomeningeal disease (LMD), a composite of these variables, and distant intracranial failure (DIF). Gray’s test compared cumulative incidence, treating death as a competing risk with a random survival forests (RSF) machine-learning model also used to evaluate the data. Results 183 patients were treated to 234 LBMs: 31.6% for postop-FSRS, 28.2% for SSRS, 20.1% for FSRS, and 20.1% for preop-SRS. The overall 1-year composite endpoint rates were comparable (21 vs 20%) between nonoperative and operative strategies, but 1-year RN rate was 8 vs 4% ( p  = 0.012), 1-year overall survival (OS) was 48 vs. 69% ( p  = 0.001), and 1-year LMD rate was 5 vs 10% ( p  = 0.052). There were differences in the 1-year RN rates (7% FSRS, 3% postop-FSRS, 5% preop-SRS, 10% SSRS, p  = 0.037). With RSF analysis, the out-of-bag error rate for the composite endpoint was 47%, with identified top-risk factors including widespread extracranial disease, &gt; 5 total lesions, and breast cancer histology. Conclusion This is the first study to conduct a head-to-head retrospective comparison of four SRS methods, addressing the lack of randomized data in LBM literature amongst treatment paradigms. 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Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of neuro-oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kutuk, Tugce</au><au>Zhang, Yanjia</au><au>Akdemir, Eyub Yasar</au><au>Yarlagadda, Sreenija</au><au>Tolakanahalli, Ranjini</au><au>Hall, Matthew D.</au><au>La Rosa, Alonso</au><au>Wieczorek, DJay J.</au><au>Lee, Yongsook C.</au><au>Press, Robert H.</au><au>Appel, Haley</au><au>McDermott, Michael W.</au><au>Odia, Yazmin</au><au>Ahluwalia, Manmeet S.</au><au>Gutierrez, Alonso N.</au><au>Mehta, Minesh P.</au><au>Kotecha, Rupesh</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Comparative evaluation of outcomes amongst different radiosurgery management paradigms for patients with large brain metastasis</atitle><jtitle>Journal of neuro-oncology</jtitle><stitle>J Neurooncol</stitle><addtitle>J Neurooncol</addtitle><date>2024-08-01</date><risdate>2024</risdate><volume>169</volume><issue>1</issue><spage>105</spage><epage>117</epage><pages>105-117</pages><issn>0167-594X</issn><issn>1573-7373</issn><eissn>1573-7373</eissn><abstract>Introduction This study compares four management paradigms for large brain metastasis (LMB): fractionated SRS (FSRS), staged SRS (SSRS), resection and postoperative-FSRS (postop-FSRS) or preoperative-SRS (preop-SRS). Methods Patients with LBM (≥ 2 cm) between July 2017 and January 2022 at a single tertiary institution were evaluated. Primary endpoints were local failure (LF), radiation necrosis (RN), leptomeningeal disease (LMD), a composite of these variables, and distant intracranial failure (DIF). Gray’s test compared cumulative incidence, treating death as a competing risk with a random survival forests (RSF) machine-learning model also used to evaluate the data. Results 183 patients were treated to 234 LBMs: 31.6% for postop-FSRS, 28.2% for SSRS, 20.1% for FSRS, and 20.1% for preop-SRS. The overall 1-year composite endpoint rates were comparable (21 vs 20%) between nonoperative and operative strategies, but 1-year RN rate was 8 vs 4% ( p  = 0.012), 1-year overall survival (OS) was 48 vs. 69% ( p  = 0.001), and 1-year LMD rate was 5 vs 10% ( p  = 0.052). There were differences in the 1-year RN rates (7% FSRS, 3% postop-FSRS, 5% preop-SRS, 10% SSRS, p  = 0.037). With RSF analysis, the out-of-bag error rate for the composite endpoint was 47%, with identified top-risk factors including widespread extracranial disease, &gt; 5 total lesions, and breast cancer histology. Conclusion This is the first study to conduct a head-to-head retrospective comparison of four SRS methods, addressing the lack of randomized data in LBM literature amongst treatment paradigms. Despite patient characteristic trends, no significant differences were found in LF, composite endpoint, and DIF rates between non-operative and operative approaches.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>38837019</pmid><doi>10.1007/s11060-024-04706-2</doi><tpages>13</tpages></addata></record>
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subjects Adult
Aged
Brain cancer
Brain Neoplasms - mortality
Brain Neoplasms - radiotherapy
Brain Neoplasms - secondary
Brain Neoplasms - surgery
Female
Follow-Up Studies
Humans
Male
Medicine
Medicine & Public Health
Meninges
Metastases
Metastasis
Middle Aged
Neurology
Oncology
Radiosurgery
Radiosurgery - methods
Retrospective Studies
Risk factors
Survival
Survival Rate
Treatment Outcome
title Comparative evaluation of outcomes amongst different radiosurgery management paradigms for patients with large brain metastasis
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