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Prognostic analysis of stereotactic radiosurgery for brain metastases: a single-center retrospective study

  • Radiotherapy
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Objectives

Brain metastasis (BM) is a common event during the development of many cancers, and is also one of the main causes of death of patients. Stereotactic radiosurgery (SRS) is an effective treatment for BM. The prognostic effects of various clinical factors on local control (LC) and overall survival (OS) after SRS treatment are still unclear. The purpose of this study is to retrospectively analyze the intracranial progression free survival (iPFS) and OS of patients receiving SRS treatment, and explore the relationship between various clinical characteristics and patient prognosis.

Materials and methods

We collected the clinical information of patients who were diagnosed with BM and received SRS treatment in our center between 2018 and 2021. Univariate and multivariate Cox regression analysis and KM analysis for iPFS and OS were conducted in R software to investigate the prognostic effects of clinical characteristics.

Results

In total, 183 patients that received SRS in our center were enrolled in the cohort. The median iPFS for all patients was 8.87 months (95% CI 6.9–10.6), and the median OS was 16.5 months (95% CI 12.9–20.7). BM number >  = 5 (HR 1.965 [95% CI 1.381–2.796], p < 0.001, FDR-corrected p < 0.001) was found to be strong predictor for shorter iPFS and OS. Subgroup analysis showed that patients with cumulative intracranial tumor volume (CITV) >  = 2.14 cm3 and number >  = 5 had shortest iPFS (P < 0.001) and OS (P = 0.007), compared with other subgroups. For patients with more than 5 BMs, SRS plus whole brain radiotherapy (WBRT) could achieve better local control, compared with SRS alone group (P = 0.0357). Peripheral blood inflammation indicators were associated with the prognosis of BM patients in univariate Cox analysis, but not in multivariate Cox analysis.

Conclusions

BM number is an independent prognostic factor for BM patients. The prognosis of patients in the subgroup with larger CITV and more BM is the worst. For patients with more than 5 BM, the combination of SRS and WBRT can improve the local control, but cannot prolong the OS.

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Abbreviations

BM:

Brain metastasis

SRS:

Stereotactic radiosurgery

LC:

Local control

OS:

Overall survival

iPFS:

Intracranial progression free survival

WBRT:

Whole brain radiotherapy

WLR:

White cell-to lymphocyte ratio

NLR:

Neutrophil-to-lymphocyte ratio

MLR:

Monocyte-to-lymphocyte ratio

PLR:

Platelet-to-lymphocyte ratio

KM:

Kaplan–Meier survival curve

ECM:

Extracranial metastases

PD:

Progression disease

SD:

Stable disease

PR:

Partial remission

CITV:

Cumulative intracranial tumor volume

BED10 :

Biological equivalent dose with α/β = 10

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  1. Department of Radiation Oncology, The First Affiliated Hospital of China Medical University, No.155 North NanJing Street, Heping District, Shenyang, 110001, Liaoning, China

    Yongping Hao, Ting Tang, Jing Ren & Guang Li

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Contributions

YH: design of study, drafting; TT and JR: collecting data and design of study; GL: providing substantial conception and suggestions. All authors gave final approval for submission of the manuscript.

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Correspondence to Guang Li.

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This retrospective analysis of patient data was approved by the local ethics committee ([2022]438).

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Hao, Y., Tang, T., Ren, J. et al. Prognostic analysis of stereotactic radiosurgery for brain metastases: a single-center retrospective study. Radiol med 128, 1271–1283 (2023). https://doi.org/10.1007/s11547-023-01698-3

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