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Management patterns of patients with cerebral metastases who underwent multiple stereotactic radiosurgeries

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Abstract

With escalating focus on cost containment, there is increasing scrutiny on the practice of multiple stereotactic radiosurgeries (SRSs) for patients with cerebral metastases distant to the initial tumor site. Our goal was to determine the survival patterns of patients with cerebral metastasis who underwent multiple SRSs. We retrospectively analyzed survival outcomes of 801 patients with 3683 cerebral metastases from primary breast, colorectal, lung, melanoma and renal histologies consecutively treated at the University of California, San Diego/San Diego Gamma Knife Center (UCSD/SDGKC), comparing the survival pattern of patients who underwent a single (n = 643) versus multiple SRS(s) (n = 158) for subsequent cerebral metastases. Findings were recapitulated in an independent cohort of 2472 patients, with 26,629 brain metastases treated with SRS at the Katsuta Hospital Mito GammaHouse (KHMGH). For the UCSD/SDGKC cohort, no significant difference in median survival was found for patients undergoing 1, 2, 3, or ≥4 SRS(s) (median survival of 167, 202, 129, and 127 days, respectively). Median intervals between treatments consistently ranged 140–178 days irrespective of the number of SRS(s) (interquartile range 60–300; p = 0.25). Patients who underwent >1 SRSs tend to be younger, with systemic disease control, harbor lower cumulative tumor volume but increased number of metastases, and have primary melanoma (p < 0.001, <0.001, <0.001, 0.02, and 0.009, respectively). Comparable results were found in the KHMGH cohort. Using an independent validation study design, we demonstrated comparable overall survival between judiciously selected patients who underwent a single or multiple SRS(s).

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Acknowledgments

This study was funded in part by the National Institutes of Health (TL1TR00098 to D.C.M.; KL2TR00099 to J.H.G.; and, UL1TR000100 to J.H.G.).

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    Authors and Affiliations

    1. Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, USA

      Deborah C. Marshall & Jona A. Hattangadi-Gluth

    2. Los Angeles Medical Center, University of California, Los Angeles, USA

      Logan P. Marcus

    3. Wake Forest Baptist Health, Winston-Salem, USA

      Teddy E. Kim

    4. Mayo School of Graduate Medical Education, Rochester, USA

      Brandon A. McCutcheon

    5. San Diego Gamma Knife Center, San Diego, USA

      Steven J. Goetsch & Kenneth Ott

    6. Katsuta Hospital Mito GammaHouse, Hitachi-Naka, Japan

      Takao Koiso & Masaaki Yamamoto

    7. Center for Translational and Applied Neuro-Oncology, Division of Neurosurgery, University of California, San Diego, 3855 Health Science Drive #0987, La Jolla, CA, 92093-0987, USA

      John F. Alksne, Bob S. Carter & Clark C. Chen

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    1. Deborah C. Marshall
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    Correspondence to Clark C. Chen.

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    For this type of study formal consent is not required. The study protocol was approved by the Institutional Review Board.

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    Masaaki Yamamoto and Clark C. Chen are equal contributions as senior authors.

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    Marshall, D.C., Marcus, L.P., Kim, T.E. et al. Management patterns of patients with cerebral metastases who underwent multiple stereotactic radiosurgeries. J Neurooncol 128, 119–128 (2016). https://doi.org/10.1007/s11060-016-2084-2

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