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Stereotactic radiosurgery for small brain metastases and implications regarding management with systemic therapy alone

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Abstract

While stereotactic radiosurgery (SRS) has been shown effective in the management of brain metastases, small brain metastases (≤10 mm) can pose unique challenges. Our aim was to investigate the efficacy of SRS in the treatment of small brain metastases, as well as elucidate clinically relevant factors impacting local failure (LF). We utilized a large, single-institution cohort to perform a retrospective analysis of patients with brain metastases up to 1 cm in maximal dimension. Clinical and radiosurgical parameters were investigated for an association with LF and compared using a competing risk model to calculate cumulative incidence functions, with death and whole brain radiotherapy serving as competing risks. 1596 small brain metastases treated with SRS among 424 patients were included. Among these tumors, 33 developed LF during the follow-up period (2.4% at 12 months following SRS). Competing risk analysis demonstrated that LF was dependent on tumor size (0.7% if ≤2 mm and 3.0% if 2–10 mm at 12 months, p = 0.016). Other factors associated with increasing risk of LF were the decreasing margin dose, increasing maximal tumor diameter, volume, and radioresistant tumors (each p < 0.01). 22 tumors (0.78%) developed radiographic radiation necrosis following SRS, and this incidence did not differ by tumor size (≤2 mm and 2–10 mm, p = 0.200). This large analysis confirms that SRS remains an effective modality in treatment of small brain metastases. In light of the excellent local control and relatively low risk of toxicity, patients with small brain metastases who otherwise have a reasonable expected survival should be considered for radiosurgical management.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Virginia, Charlottesville, VA, USA

    Daniel M. Trifiletti, Colin Hill & Jason P. Sheehan

  2. Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA

    Or Cohen-Inbar, Zhiyuan Xu & Jason P. Sheehan

  3. Department of Radiation Oncology, University of Virginia Health System, 1240 Lee Street, Box 800383, Charlottesville, VA, 22908, USA

    Daniel M. Trifiletti

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  1. Daniel M. Trifiletti
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Correspondence to Daniel M. Trifiletti.

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Trifiletti, D.M., Hill, C., Cohen-Inbar, O. et al. Stereotactic radiosurgery for small brain metastases and implications regarding management with systemic therapy alone. J Neurooncol 134, 289–296 (2017). https://doi.org/10.1007/s11060-017-2519-4

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