Factors correlating with survival following adjuvant or definitive radiosurgery for large brain metastases

摘要

Abstract Background We sought to identify variates correlating with overall survival (OS) in patients treated with surgery (S) plus adjuvant stereotactic radiosurgery (SRS) versus definitive SRS for large (>4 cc) brain metastases (BrM).Methods We used univariate (UVA) and multivariate analyses (MVA) to identify survival correlates among eligible patients identified from a prospective registry and compared definitive SRS to S+ adjuvant SRS cohorts using propensity score-matched analysis (PSMA). Secondary outcomes were measured using the cumulative incidence (CI) method.Results We identified 364 patients; 127 and 237 were treated with S+SRS and definitive SRS, respectively. On UVA, SRS alone HR1.73 (1.35,2.22) P < .001), BrM quantity HR 1.13 (1.06–1.22) (P < .001); performance status (PS) HR 2.78 (1.73–4.46) (P < .001); extracranial disease (ECD) HR 1.82 (1.37,2.40) (P < .001); and receipt of systemic treatment after BrM therapy, HR 0.58 (0.46–073) (P < .001) correlated with OS. On MVA, SRS alone HR 1.81 (1.19,2.74) (P < .0054), SRS target volume HR 1.03 (1.01,1.06) (P < .0042), and receipt of systemic treatment HR 0.68 (0.50,0.93) (P < .015) correlated with OS. When PSMA was used to balance ECD, BrM quantity, PS, and SRS target volume, SRS alone remained correlated with worsened OS HR 1.62 (1.20–2.19) (P = 0.0015). CI of local failure requiring resection at 12 months was 3 versus 7 for S+SRS and SRS cohorts, respectively (HR 2.04 (0.89–4.69) (P = .091). CI of pachymeningeal failure at 12 months was 16 versus 0 for S+SRS and SRS.Conclusion SRS target volume, receipt of systemic therapies, and treatment with S+SRS instead of definitive SRS correlated with improved survival in patients with large BrM.