The growing importance of lesion volume as a prognostic factor in patients with multiple brain metastases treated with stereotactic radiosurgery
Abstract Stereotactic Radiosurgery (SRS) is considered standard of care for patients with 1–3 brain metastases (BM). Recent observational studies have shown equivalent OS in patients with 5+ BM compared to those with 2–4, suggesting SRS alone may be appropriate in these patients. We aim to review ou...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2018-03-01
|
| Series: | Cancer Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/cam4.1352 |
| _version_ | 1797390077083516928 |
|---|---|
| author | David M. Routman Shelly X. Bian Kevin Diao Jonathan L. Liu Cheng Yu Jason Ye Gabriel Zada Eric L. Chang |
| author_facet | David M. Routman Shelly X. Bian Kevin Diao Jonathan L. Liu Cheng Yu Jason Ye Gabriel Zada Eric L. Chang |
| author_sort | David M. Routman |
| collection | DOAJ |
| description | Abstract Stereotactic Radiosurgery (SRS) is considered standard of care for patients with 1–3 brain metastases (BM). Recent observational studies have shown equivalent OS in patients with 5+ BM compared to those with 2–4, suggesting SRS alone may be appropriate in these patients. We aim to review outcomes of patients treated with SRS with 2–4 versus 5+ BM. This analysis included consecutive patients from 1994 to 2015 treated with SRS. Of 1017 patients, we excluded patients with a single BM and patients without adequate survival data, resulting in 391 patients. All risk factors were entered into univariate analysis using Cox proportional hazards model, and significant factors were entered into multivariate analysis (MVA). We additionally analyzed outcomes after excluding patients with prior surgery or whole‐brain radiotherapy (WBRT). Median follow‐up was 7.1 months. Median KPS was 90, mean age was 59, and most common histologies were melanoma and lung. Median tumor volume was 3.41 cc. Patients with 2–4 BM had a median OS of 8.1 months compared to 6.2 months for those with 5+ BM (P = 0.0136). On MVA, tumor volume, KPS, and histology remained significant for OS, whereas lesion number did not. Similar results were found when excluding patients with prior surgery or WBRT. Rather than lesion number, the strongest prognostic factors for patients undergoing SRS were tumor volume >10 cc, KPS, and histology. BM number may therefore not be the most important criterion for candidacy for SRS. Patients with 5 or more BM should be considered for SRS. |
| first_indexed | 2024-03-08T23:06:22Z |
| format | Article |
| id | doaj.art-5ab6727ab1964b2bb3715733bca1e0e8 |
| institution | Directory Open Access Journal |
| issn | 2045-7634 |
| language | English |
| last_indexed | 2024-03-08T23:06:22Z |
| publishDate | 2018-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Cancer Medicine |
| spelling | doaj.art-5ab6727ab1964b2bb3715733bca1e0e82023-12-15T12:32:12ZengWileyCancer Medicine2045-76342018-03-017375776410.1002/cam4.1352The growing importance of lesion volume as a prognostic factor in patients with multiple brain metastases treated with stereotactic radiosurgeryDavid M. Routman0Shelly X. Bian1Kevin Diao2Jonathan L. Liu3Cheng Yu4Jason Ye5Gabriel Zada6Eric L. Chang7Department of Radiation Oncology Mayo Clinic Rochester MinnesotaDepartment of Radiation Oncology Keck School of Medicine of USC Los Angeles CaliforniaDepartment of Radiation Oncology Keck School of Medicine of USC Los Angeles CaliforniaDepartment of Radiology Washington University St. Louis MissouriDepartment of Radiation Oncology Keck School of Medicine of USC Los Angeles CaliforniaDepartment of Radiation Oncology Keck School of Medicine of USC Los Angeles CaliforniaDepartment of Neurological Surgery Keck School of Medicine of USC Los Angeles CaliforniaDepartment of Radiation Oncology Keck School of Medicine of USC Los Angeles CaliforniaAbstract Stereotactic Radiosurgery (SRS) is considered standard of care for patients with 1–3 brain metastases (BM). Recent observational studies have shown equivalent OS in patients with 5+ BM compared to those with 2–4, suggesting SRS alone may be appropriate in these patients. We aim to review outcomes of patients treated with SRS with 2–4 versus 5+ BM. This analysis included consecutive patients from 1994 to 2015 treated with SRS. Of 1017 patients, we excluded patients with a single BM and patients without adequate survival data, resulting in 391 patients. All risk factors were entered into univariate analysis using Cox proportional hazards model, and significant factors were entered into multivariate analysis (MVA). We additionally analyzed outcomes after excluding patients with prior surgery or whole‐brain radiotherapy (WBRT). Median follow‐up was 7.1 months. Median KPS was 90, mean age was 59, and most common histologies were melanoma and lung. Median tumor volume was 3.41 cc. Patients with 2–4 BM had a median OS of 8.1 months compared to 6.2 months for those with 5+ BM (P = 0.0136). On MVA, tumor volume, KPS, and histology remained significant for OS, whereas lesion number did not. Similar results were found when excluding patients with prior surgery or WBRT. Rather than lesion number, the strongest prognostic factors for patients undergoing SRS were tumor volume >10 cc, KPS, and histology. BM number may therefore not be the most important criterion for candidacy for SRS. Patients with 5 or more BM should be considered for SRS.https://doi.org/10.1002/cam4.1352Brain metastaseslesion numberstereotactic radiosurgerytumor volumewhole‐brain radiation therapy |
| spellingShingle | David M. Routman Shelly X. Bian Kevin Diao Jonathan L. Liu Cheng Yu Jason Ye Gabriel Zada Eric L. Chang The growing importance of lesion volume as a prognostic factor in patients with multiple brain metastases treated with stereotactic radiosurgery Cancer Medicine Brain metastases lesion number stereotactic radiosurgery tumor volume whole‐brain radiation therapy |
| title | The growing importance of lesion volume as a prognostic factor in patients with multiple brain metastases treated with stereotactic radiosurgery |
| title_full | The growing importance of lesion volume as a prognostic factor in patients with multiple brain metastases treated with stereotactic radiosurgery |
| title_fullStr | The growing importance of lesion volume as a prognostic factor in patients with multiple brain metastases treated with stereotactic radiosurgery |
| title_full_unstemmed | The growing importance of lesion volume as a prognostic factor in patients with multiple brain metastases treated with stereotactic radiosurgery |
| title_short | The growing importance of lesion volume as a prognostic factor in patients with multiple brain metastases treated with stereotactic radiosurgery |
| title_sort | growing importance of lesion volume as a prognostic factor in patients with multiple brain metastases treated with stereotactic radiosurgery |
| topic | Brain metastases lesion number stereotactic radiosurgery tumor volume whole‐brain radiation therapy |
| url | https://doi.org/10.1002/cam4.1352 |
| work_keys_str_mv | AT davidmroutman thegrowingimportanceoflesionvolumeasaprognosticfactorinpatientswithmultiplebrainmetastasestreatedwithstereotacticradiosurgery AT shellyxbian thegrowingimportanceoflesionvolumeasaprognosticfactorinpatientswithmultiplebrainmetastasestreatedwithstereotacticradiosurgery AT kevindiao thegrowingimportanceoflesionvolumeasaprognosticfactorinpatientswithmultiplebrainmetastasestreatedwithstereotacticradiosurgery AT jonathanlliu thegrowingimportanceoflesionvolumeasaprognosticfactorinpatientswithmultiplebrainmetastasestreatedwithstereotacticradiosurgery AT chengyu thegrowingimportanceoflesionvolumeasaprognosticfactorinpatientswithmultiplebrainmetastasestreatedwithstereotacticradiosurgery AT jasonye thegrowingimportanceoflesionvolumeasaprognosticfactorinpatientswithmultiplebrainmetastasestreatedwithstereotacticradiosurgery AT gabrielzada thegrowingimportanceoflesionvolumeasaprognosticfactorinpatientswithmultiplebrainmetastasestreatedwithstereotacticradiosurgery AT ericlchang thegrowingimportanceoflesionvolumeasaprognosticfactorinpatientswithmultiplebrainmetastasestreatedwithstereotacticradiosurgery AT davidmroutman growingimportanceoflesionvolumeasaprognosticfactorinpatientswithmultiplebrainmetastasestreatedwithstereotacticradiosurgery AT shellyxbian growingimportanceoflesionvolumeasaprognosticfactorinpatientswithmultiplebrainmetastasestreatedwithstereotacticradiosurgery AT kevindiao growingimportanceoflesionvolumeasaprognosticfactorinpatientswithmultiplebrainmetastasestreatedwithstereotacticradiosurgery AT jonathanlliu growingimportanceoflesionvolumeasaprognosticfactorinpatientswithmultiplebrainmetastasestreatedwithstereotacticradiosurgery AT chengyu growingimportanceoflesionvolumeasaprognosticfactorinpatientswithmultiplebrainmetastasestreatedwithstereotacticradiosurgery AT jasonye growingimportanceoflesionvolumeasaprognosticfactorinpatientswithmultiplebrainmetastasestreatedwithstereotacticradiosurgery AT gabrielzada growingimportanceoflesionvolumeasaprognosticfactorinpatientswithmultiplebrainmetastasestreatedwithstereotacticradiosurgery AT ericlchang growingimportanceoflesionvolumeasaprognosticfactorinpatientswithmultiplebrainmetastasestreatedwithstereotacticradiosurgery |