Local control after radiosurgery for brain metastases: predictive factors and implications for clinical decision

Radiation Oncology

Douglas Guedes de Castro¹  Paulo Issamu Sanematsu Jr²  José Eduardo Souza Dias Jr²  Sérgio Hideki Suzuki²  Michael Jenwei Chen¹  Ricardo César Fogaroli¹  Maria Letícia Gobo Silva¹  Antônio Cássio Assis Pellizzon¹  Maria Aparecida Conte Maia¹  Henderson Ramos¹  Carmen Freire Tundisi¹  Tâmara Ribeiro de Azevedo Santos¹ 

[1] Department of Radiation Oncology, AC Camargo Cancer Center, São Paulo, Brazil;Department of Neurosurgery, AC Camargo Cancer Center, São Paulo, Brazil

关键词: Whole-Brain Radiotherapy;    Brain Metastases;    Radiosurgery;   

Others  :  1139646
DOI  :  10.1186/s13014-015-0367-y

 received in 2014-12-14, accepted in 2015-02-23,  发布年份 2015

【 摘 要 】

Background

To evaluate the local control of brain metastases (BM) in patients treated with stereotactic radiosurgery (SRS), correlate the outcome with treatment parameters and lesion characteristics, and define its implications for clinical decisions.

Methods

Between 2007 and 2012, 305 BM in 141 consecutive patients were treated with SRS. After exclusions, 216 BM in 100 patients were analyzed. Doses were grouped as follows: ≤15 Gy, 16–20 Gy, and ≥21 Gy. Sizes were classified as ≤10 mm and >10 mm. Local control (LC) and overall survival (OS) were estimated using the Kaplan-Meier method. Log-rank statistics were used to identify the prognostic factors affecting LC and OS. For multivariate analyses, a Cox proportional model was applied including all potentially significant variables reached on univariate analyses.

Results

Median age was 54 years (18–80). Median radiological follow-up of the lesions was 7 months (1–66). Median LC and the LC at 1 year were 22.3 months and 69.7%, respectively. On univariate analysis, tumor size, SRS dose, and previous whole brain irradiation (WBRT) were significant factors for LC. Patients with lesions >10 and ≤10 mm had an LC at 1 year of 58.6% and 79.1%, respectively (p = 0.008). In lesions receiving ≤15 Gy, 16–20 Gy, and ≥21 Gy, the 1-year LC rates were 39.6%, 71.7%, and 92.3%, respectively (p < 0.001). When WBRT was done previously, LC at 1 year was 57.9% compared with 78.4% for those who did not undergo WBRT (p = 0.004). On multivariate analysis, dose remained the single most powerful prognostic factor for LC. Median OS for all patients was 17 months, with no difference among the groups.

Conclusions

Dose is the most important predictive factor for LC of BM. Doses below 16 Gy correlated with poor LC. The SRS dose as salvage treatment after previous WBRT should not be reduced unless there is a pressing reason to do so.

【 授权许可】

   
2015 Santos et al.; licensee BioMed Central.

【 图 表 】

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