Skip to main content
Journal cover image

Outcomes in Patients with Intact and Resected Brain Metastasis Treated with 5-Fraction Stereotactic Radiosurgery.

Publication ,  Journal Article
Carpenter, DJ; Fairchild, AT; Adamson, JD; Fecci, PE; Sampson, JH; Herndon, JE; Torok, JA; Mullikin, TC; Kim, GJ; Reitman, ZJ; Kirkpatrick, JP ...
Published in: Adv Radiat Oncol
2023

PURPOSE: Hypofractionated stereotactic radiosurgery (HF-SRS) with or without surgical resection is potentially a preferred treatment for larger or symptomatic brain metastases (BMs). Herein, we report clinical outcomes and predictive factors following HF-SRS. METHODS AND MATERIALS: Patients undergoing HF-SRS for intact (iHF-SRS) or resected (rHF-SRS) BMs from 2008 to 2018 were retrospectively identified. Linear accelerator-based image-guided HF-SRS consisted of 5 fractions at 5, 5.5, or 6 Gy per fraction. Time to local progression (LP), time to distant brain progression (DBP), and overall survival (OS) were calculated. Cox models assessed effect of clinical factors on OS. Fine and Gray's cumulative incidence model for competing events examined effect of factors on LP and DBP. The occurrence of leptomeningeal disease (LMD) was determined. Logistic regression examined predictors of LMD. RESULTS: Among 445 patients, median age was 63.5 years; 87% had Karnofsky performance status ≥70. Fifty-three % of patients underwent surgical resection, and 75% received 5 Gy per fraction. Patients with resected BMs had higher Karnofsky performance status (90-100, 41 vs 30%), less extracranial disease (absent, 25 vs 13%), and fewer BMs (multiple, 32 vs 67%). Median diameter of the dominant BM was 3.0 cm (interquartile range, 1.8-3.6 cm) for intact BMs and 4.6 cm (interquartile range, 3.9-5.5 cm) for resected BMs. Median OS was 5.1 months (95% confidence interval [CI], 4.3-6.0) following iHF-SRS and 12.8 months (95% CI, 10.8-16.2) following rHF-SRS (P < .01). Cumulative LP incidence was 14.5% at 18 months (95% CI, 11.4-18.0%), significantly associated with greater total GTV (hazard ratio, 1.12; 95% CI, 1.05-1.20) following iFR-SRS, and with recurrent versus newly diagnosed BMs across all patients (hazard ratio, 2.28; 95% CI, 1.01-5.15). Cumulative DBP incidence was significantly greater following rHF-SRS than iHF-SRS (P = .01), with respective 24-month rates of 50.0 (95% CI, 43.3-56.3) and 35.7% (95% CI, 29.2-42.2). LMD (57 events total; 33% nodular, 67% diffuse) was observed in 17.1% of rHF-SRS and 8.1% of iHF-SRS cases (odds ratio, 2.46; 95% CI, 1.34-4.53). Any radionecrosis and grade 2+ radionecrosis events were observed in 14 and 8% of cases, respectively. CONCLUSIONS: HF-SRS demonstrated favorable rates of LC and radionecrosis in postoperative and intact settings. Corresponding LMD and RN rates were comparable to those of other studies.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Adv Radiat Oncol

DOI

ISSN

2452-1094

Publication Date

2023

Volume

8

Issue

2

Start / End Page

101166

Location

United States

Related Subject Headings

  • 3211 Oncology and carcinogenesis
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Carpenter, D. J., Fairchild, A. T., Adamson, J. D., Fecci, P. E., Sampson, J. H., Herndon, J. E., … Floyd, S. R. (2023). Outcomes in Patients with Intact and Resected Brain Metastasis Treated with 5-Fraction Stereotactic Radiosurgery. Adv Radiat Oncol, 8(2), 101166. https://doi.org/10.1016/j.adro.2022.101166
Carpenter, David J., Andrew T. Fairchild, Justus D. Adamson, Peter E. Fecci, John H. Sampson, James E. Herndon, Jordan A. Torok, et al. “Outcomes in Patients with Intact and Resected Brain Metastasis Treated with 5-Fraction Stereotactic Radiosurgery.Adv Radiat Oncol 8, no. 2 (2023): 101166. https://doi.org/10.1016/j.adro.2022.101166.
Carpenter DJ, Fairchild AT, Adamson JD, Fecci PE, Sampson JH, Herndon JE, et al. Outcomes in Patients with Intact and Resected Brain Metastasis Treated with 5-Fraction Stereotactic Radiosurgery. Adv Radiat Oncol. 2023;8(2):101166.
Carpenter, David J., et al. “Outcomes in Patients with Intact and Resected Brain Metastasis Treated with 5-Fraction Stereotactic Radiosurgery.Adv Radiat Oncol, vol. 8, no. 2, 2023, p. 101166. Pubmed, doi:10.1016/j.adro.2022.101166.
Carpenter DJ, Fairchild AT, Adamson JD, Fecci PE, Sampson JH, Herndon JE, Torok JA, Mullikin TC, Kim GJ, Reitman ZJ, Kirkpatrick JP, Floyd SR. Outcomes in Patients with Intact and Resected Brain Metastasis Treated with 5-Fraction Stereotactic Radiosurgery. Adv Radiat Oncol. 2023;8(2):101166.
Journal cover image

Published In

Adv Radiat Oncol

DOI

ISSN

2452-1094

Publication Date

2023

Volume

8

Issue

2

Start / End Page

101166

Location

United States

Related Subject Headings

  • 3211 Oncology and carcinogenesis