Response of treatment-naive brain metastases to stereotactic radiosurgery

Chibawanye I. Ene (), Christina Abi Faraj, Thomas H. Beckham, Jeffrey S. Weinberg, Clark R. Andersen, Ali S. Haider, Ganesh Rao, Sherise D. Ferguson, Christopher A. Alvarez-Brenkenridge, Betty Y. S. Kim, Amy B. Heimberger, Ian E. McCutcheon, Sujit S. Prabhu, Chenyang Michael Wang, Amol J. Ghia, Susan L. McGovern, Caroline Chung, Mary Frances McAleer, Martin C. Tom, Subha Perni, Todd A. Swanson, Debra N. Yeboa, Tina M. Briere, Jason T. Huse, Gregory N. Fuller, Frederick F. Lang, Jing Li, Dima Suki and Raymond E. Sawaya
Additional contact information
Chibawanye I. Ene: The University of Texas M D Anderson Cancer Center
Christina Abi Faraj: The University of Texas M D Anderson Cancer Center
Thomas H. Beckham: The University of Texas M D Anderson Cancer Center
Jeffrey S. Weinberg: The University of Texas M D Anderson Cancer Center
Clark R. Andersen: The University of Texas M D Anderson Cancer Center
Ali S. Haider: The University of Texas M D Anderson Cancer Center
Ganesh Rao: Baylor College of Medicine
Sherise D. Ferguson: The University of Texas M D Anderson Cancer Center
Christopher A. Alvarez-Brenkenridge: The University of Texas M D Anderson Cancer Center
Betty Y. S. Kim: The University of Texas M D Anderson Cancer Center
Amy B. Heimberger: Northwestern University
Ian E. McCutcheon: The University of Texas M D Anderson Cancer Center
Sujit S. Prabhu: The University of Texas M D Anderson Cancer Center
Chenyang Michael Wang: The University of Texas M D Anderson Cancer Center
Amol J. Ghia: The University of Texas M D Anderson Cancer Center
Susan L. McGovern: The University of Texas M D Anderson Cancer Center
Caroline Chung: The University of Texas M D Anderson Cancer Center
Mary Frances McAleer: The University of Texas M D Anderson Cancer Center
Martin C. Tom: The University of Texas M D Anderson Cancer Center
Subha Perni: The University of Texas M D Anderson Cancer Center
Todd A. Swanson: The University of Texas M D Anderson Cancer Center
Debra N. Yeboa: The University of Texas M D Anderson Cancer Center
Tina M. Briere: The University of Texas M D Anderson Cancer Center
Jason T. Huse: The University of Texas M D Anderson Cancer Center
Gregory N. Fuller: The University of Texas M D Anderson Cancer Center
Frederick F. Lang: The University of Texas M D Anderson Cancer Center
Jing Li: The University of Texas M D Anderson Cancer Center
Dima Suki: The University of Texas M D Anderson Cancer Center
Raymond E. Sawaya: American University of Beirut

Nature Communications, 2024, vol. 15, issue 1, 1-10

Abstract: Abstract With improvements in survival for patients with metastatic cancer, long-term local control of brain metastases has become an increasingly important clinical priority. While consensus guidelines recommend surgery followed by stereotactic radiosurgery (SRS) for lesions >3 cm, smaller lesions (≤3 cm) treated with SRS alone elicit variable responses. To determine factors influencing this variable response to SRS, we analyzed outcomes of brain metastases ≤3 cm diameter in patients with no prior systemic therapy treated with frame-based single-fraction SRS. Following SRS, 259 out of 1733 (15%) treated lesions demonstrated MRI findings concerning for local treatment failure (LTF), of which 202 /1733 (12%) demonstrated LTF and 54/1733 (3%) had an adverse radiation effect. Multivariate analysis demonstrated tumor size (>1.5 cm) and melanoma histology were associated with higher LTF rates. Our results demonstrate that brain metastases ≤3 cm are not uniformly responsive to SRS and suggest that prospective studies to evaluate the effect of SRS alone or in combination with surgery on brain metastases ≤3 cm matched by tumor size and histology are warranted. These studies will help establish multi-disciplinary treatment guidelines that improve local control while minimizing radiation necrosis during treatment of brain metastasis ≤3 cm.

Date: 2024
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DOI: 10.1038/s41467-024-47998-8

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