Journal of Neuro-Oncology

, Volume 142, Issue 2, pp 355–363 | Cite as

Local control after brain-directed radiation in patients with cystic versus solid brain metastases

  • Rachel H. Brigell
  • Daniel N. CagneyEmail author
  • Allison M. Martin
  • Luke A. Besse
  • Paul J. Catalano
  • Eudocia Q. Lee
  • Patrick Y. Wen
  • Paul D. Brown
  • John G. Phillips
  • Itai M. Pashtan
  • Shyam K. Tanguturi
  • Daphne A. Haas-Kogan
  • Brian M. Alexander
  • Ayal A. Aizer
Clinical Study



Brain metastases can be radiographically cystic or solid. Cystic metastases are associated with a greater intracranial disease burden and poorer oncologic outcomes, but the impact of cystic versus solid appearance on local control after radiation remains unknown. We investigated whether cystic versus solid nature is predictive of local control after management with stereotactic or whole brain radiation (WBRT) and whether the radiation modality utilized is an effect modifier.


We identified 859 patients with 2211 newly-diagnosed brain metastases managed with upfront stereotactic radiation or WBRT without preceding resection/aspiration at Brigham and Women’s Hospital/Dana-Farber Cancer Institute between 2000 and 2015. Multivariable Cox regression with an interaction term and sandwich covariance matrix was used to quantify local failure.


Cystic lesions were more likely to recur than solid ones when managed with stereotactic radiation (HR 2.33, 95% CI 1.32–4.10, p = 0.004) but not WBRT (HR 0.92, 95% CI 0.62–1.36, p = 0.67), p-interaction = 0.007. 1 year local control rates for cystic versus solid metastases treated with stereotactic radiation were 75% versus 88%, respectively; estimates with WBRT were 76% versus 76%, respectively. However, no significant differences were noted between the two cohorts in post-radiation outcomes including all-cause mortality and neurologic death (p > 0.05).


Among patients with brain metastases, stereotactic radiation yields improved local control and less morbidity than WBRT, and consequently for many patients the cystic versus solid designation does not impact treatment selection. However, our results suggest that in patients with a large number of cystic brain metastases, a lower threshold to consider WBRT, as opposed to stereotactic radiation, should be employed. If our results can be confirmed, further investigation into the underlying mechanism(s) would be warranted.


Brain metastases Radiation Radiosurgery Cystic Solid Control 


Compliance with ethical standards

Conflict of interest

The authors declare no potential conflicts of interest

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

This study was approved by the Dana-Farber/Brigham and Women’s Cancer Institute Institutional Review Board. Informed consent was waived.

Supplementary material

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Supplementary material 4 (DOCX 134 KB)


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Rachel H. Brigell
    • 1
  • Daniel N. Cagney
    • 1
    Email author
  • Allison M. Martin
    • 1
  • Luke A. Besse
    • 1
  • Paul J. Catalano
    • 2
  • Eudocia Q. Lee
    • 3
  • Patrick Y. Wen
    • 3
  • Paul D. Brown
    • 4
  • John G. Phillips
    • 1
  • Itai M. Pashtan
    • 1
  • Shyam K. Tanguturi
    • 1
  • Daphne A. Haas-Kogan
    • 1
  • Brian M. Alexander
    • 1
  • Ayal A. Aizer
    • 1
  1. 1.Department of Radiation Oncology, Dana-Farber/Brigham and Women’s Cancer CenterHarvard Medical SchoolBostonUSA
  2. 2.Department of Biostatistics, Department of Biostatistics and Computational BiologyHarvard T. H. Chan School of Public Health, Dana-Farber Cancer InstituteBostonUSA
  3. 3.Department of Neuro-Oncology, Dana-Farber / Brigham and Women’s Cancer CenterHarvard Medical SchoolBostonUSA
  4. 4.Department of Radiation OncologyMayo ClinicRochesterUSA

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