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Long term survivors of stereotactic radiosurgery for brain metastases: do distant brain failures reach a plateau and what factors are associated with a brain metastasis velocity of zero?

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Abstract

Purpose

Life expectancy continues to increase for patients with brain metastases treated with stereotactic radiosurgery (SRS). The present study sought to retrospectively analyze brain metastasis patients who have survived 2 years or more, and assess for what factors may predict for a final brain metastasis velocity (BMV) of zero.

Methods

This was a single-institution retrospective study of 300 patients treated with SRS from 2001 to 2019 for brain metastases who survived greater than 2 years after first SRS. Final BMV is calculated by summing all metastases through the observed time divided by the total time in years. A BMV of zero is defined as at least 2 years of imaging follow-up without distant brain failure (DBF).

Results

Median age at first SRS is 61 (IQR: 53, 70). Kaplan-Meier estimated median overall survival is 4.9 years and time to DBF is 1.5 years (95% CI 1.2, 2.0). Twenty-eight (9.3%) patients underwent subsequent WBRT. One hundred and one (33.7%) patients never had any further brain metastases (BMV = 0) at a median follow-up time of 3.3 years. Median BMV is 0.4 (IQR: 0, 1.4). Distant brain failures reach a plateau at 4 years where the cumulative incidence of DBF is 82%. 70% of first time DBFs have occurred by 2 years. Factors significantly associated with a BMV of zero include fewer brain metastases at first SRS (HR 1.1; p = 0.0004) and Caucasian race (HR 1.5; p = 0.03).

Conclusion

Approximately one third of brain metastasis patients who live beyond 2 years after initial SRS have a BMV of zero. DBFs appear to reach a plateau at 4 years. Factors significantly associated with a BMV of zero include Caucasian race and having had a single brain metastasis at first SRS.

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Data availability

Research data are stored in an institutional repository and will be shared upon request to the corresponding.

References

  1. Devoid H-M, McTyre ER, Page BR et al (2016) Recent advances in radiosurgical management of brain metastases. Front Biosci 8:203–214

    Article  Google Scholar 

  2. Lester SC, Taksler GB, Kuremsky JG et al (2014) Clinical and economic outcomes of patients with brain metastases based on symptoms: an argument for routine brain screening of those treated with upfront radiosurgery. Cancer 120:433–441

    Article  Google Scholar 

  3. Lanier CM, Hughes R, Ahmed T et al (2019) Immunotherapy is associated with improved survival and decreased neurologic death after SRS for brain metastases from lung and melanoma primaries. Neurooncol Pract 6:402–409

    Google Scholar 

  4. Mu F, Lucas JT Jr, Watts JM et al (2015) Tumor resection with carmustine wafer placement as salvage therapy after local failure of radiosurgery for brain metastasis. J Clin Neurosci 22:561–565

    Article  CAS  Google Scholar 

  5. Brown PD, Jaeckle K, Ballman KV et al (2016) Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial. JAMA 316:401–409

    Article  Google Scholar 

  6. Chang EL, Wefel JS, Hess KR et al (2009) Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol 10:1037–1044

    Article  Google Scholar 

  7. Brown PD, Ballman KV, Cerhan JH et al (2017) Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC·3): a multicentre, randomised, controlled, phase 3 trial. Lancet Oncol 18:1049–1060

    Article  Google Scholar 

  8. Soike MH, Hughes RT, Farris M et al (2019) Does stereotactic radiosurgery have a role in the management of patients presenting with 4 or more brain metastases? Neurosurgery 84:558–566

    Article  Google Scholar 

  9. Hughes RT, Masters AH, McTyre ER et al (2019) Int J Radiat Oncol Biol Phys 104:1091–1098

    Article  Google Scholar 

  10. Dohm A, Su J, McTyre ER et al (2019) Identification of CD37, cystatin A, and IL-23A gene expression in association with brain metastasis: analysis of a prospective trial. Int J Biol Mark 31:90–97

    Article  Google Scholar 

  11. Ayala-Peacock DN, Peiffer AM, Lucas JT et al (2014) A nomogram for predicting distant brain failure in patients treated with gamma knife stereotactic radiosurgery without whole brain radiotherapy. NeuroOncology 16:1283–1288

    Google Scholar 

  12. McTyre E, Ayala-Peacock D, Contessa J et al (2018) Multi-institutional competing risks analysis of distant brain failure and salvage patterns after upfront radiosurgery without whole brain radiotherapy for brain metastasis. Ann Oncol 29:497–503

    Article  CAS  Google Scholar 

  13. Ayala-Peacock DN, Attia A, Braunstein SE et al (2017) Prediction of new brain metastases after radiosurgery: validation and analysis of performance of a multi-institutional nomogram. J Neurooncol 135:403–411

    Article  Google Scholar 

  14. Gorovets D, Ayala-Peacock D, Tybor DJ et al (2017) Int J Radiat Oncol Biol Phys 97:246–253

    Article  Google Scholar 

  15. Farris M, McTyre ER, Cramer CK et al (2017) Brain metastasis velocity: a novel prognostic metric predictive of overall survival and freedom from whole-brain radiation therapy after distant brain failure following upfront radiosurgery alone. Int J Radiat Oncol Biol Phys 98:131–141

    Article  Google Scholar 

  16. McTyre ER, Soike MH, Farris M et al (2020) Multi-institutional validation of brain metastasis velocity, a recently defined predictor of outcomes following stereotactic radiosurgery. Radiother Oncol 142:168–174

    Article  Google Scholar 

  17. Yamamoto M, Aiyama H, Koiso T et al (2019) Validity of a recently proposed prognostic grading index, brain metastasis velocity, for patients with brain metastasis undergoing multiple radiosurgical procedures. Int J Radiat Oncol Biol Phys 103:631–637

    Article  Google Scholar 

  18. Fritz C, Borsky K, Stark LS et al (2018) Repeated courses of radiosurgery for new brain metastases to defer whole brain radiotherapy: feasibility and outcome with validation of the new prognostic metric brain metastasis velocity. Front Oncol 8:551

    Article  Google Scholar 

  19. Gogineni E, Vargo JA, Glaser SM et al (2018) Long-term survivorship following stereotactic radiosurgery alone for brain metastases: risk of intracranial failure and implications for surveillance and counseling. Neurosurgery 83:203–209

    Article  Google Scholar 

  20. Shaw E, Scott C, Souhami L et al (2000) Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90–05. Int J Radiat Oncol Biol Phys 47:291–298

    Article  CAS  Google Scholar 

  21. Kotecha R, Vogel S, Suh JH et al (2016) A cure is possible: a study of 10-year survivors of brain metastases. J Neurooncol 129:545–555

    Article  Google Scholar 

  22. Johnson AG, Ruiz J, Hughes R et al (2015) Impact of systemic targeted agents on the clinical outcomes of patients with brain metastases. Oncotarget 6:18945–18955

    Article  Google Scholar 

  23. LeCompte MC, Hughes RT, Farris M et al (2020) Impact of brain metastasis velocity on neurologic death for brain metastasis patients experiencing distant brain failure after initial stereotactic radiosurgery. J Neurooncol 146:285–292

    Article  CAS  Google Scholar 

  24. Sawrie SM, Guthrie BL, Spencer SA et al (2008) Predictors of distant brain recurrence for patients with newly diagnosed brain metastases treated with stereotactic radiosurgery alone. Int J Radiat Oncol Biol Phys 70:181–186

    Article  Google Scholar 

  25. Sundaresan N, Galicich JH (1985) Surgical treatment of single brain metastases from non-small-cell lung cancer. Cancer Invest 3:107–113

    Article  CAS  Google Scholar 

  26. Yamamoto M, Serizawa T, Shuto T et al (2014) Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study. Lancet Oncol 15:387–395

    Article  Google Scholar 

  27. Niemiec M, Głogowski M, Tyc-Szczepaniak D et al (2011) Characteristics of long-term survivors of brain metastases from lung cancer. Rep Pract Oncol Radiother 16:49–53

    Article  Google Scholar 

  28. Alphonse-Sullivan N, Taksler GB, Lycan T et al (2017) Sociodemographic predictors of patients with brain metastases treated with stereotactic radiosurgery. Oncotarget 8:101005–101011

    Article  Google Scholar 

Download references

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA

    Claire M. Lanier, Jane Pearce, Christina K. Cramer & Michael D. Chan

  2. Department of Biostatistics, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Scott Isom & Christopher T. Whitlow

  3. Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Fei Xing & Hui-Wen Lo

  4. Department of Radiology, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Christopher T. Whitlow

  5. Department of Internal Medicine (Hematology & Oncology), Wake Forest School of Medicine, Winston-Salem, NC, USA

    Jimmy Ruiz

  6. Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, USA

    Jaclyn J. White, Adrian W. Laxton & Stephen B. Tatter

Authors
  1. Claire M. Lanier
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  2. Jane Pearce
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Contributions

All authors contributed to the study conception and design. Data collection was performed by CML, MD Material preparation was performed by CML, MD and MDC, MD Analysis was performed by SI, MS The first draft of the manuscript was written by MDC, MD and CML, MD All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Claire M. Lanier.

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Competing interest

Financial interests: Adrian W. Laxton, M.D. has received a consulting fee from Monteris Medical. There are no other financial interests to disclose.

Ethical approval

This is an observational study. The IRB Research Ethics Committee has confirmed that no ethical approval is required.

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Due to the retrospective and observational nature of this study, the IRB Research Ethics Committee has confirmed no consent to participate is required.

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Due to the retrospective and observational nature of this study, the IRB Research Ethics Committee has confirmed no consent to publish is required.

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Lanier, C.M., Pearce, J., Isom, S. et al. Long term survivors of stereotactic radiosurgery for brain metastases: do distant brain failures reach a plateau and what factors are associated with a brain metastasis velocity of zero?. J Neurooncol 160, 643–648 (2022). https://doi.org/10.1007/s11060-022-04183-5

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  • DOI: https://doi.org/10.1007/s11060-022-04183-5

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