title: Stereotactic radiosurgery in the treatment of brain metastases from gastrointestinal primaries.
abstract: Brain metastases from gastrointestinal (GI) primary malignancies are generally less common than those arising from other primary locations. Our purpose was to analyze the efficacy of stereotactic radiosurgery (SRS) in the treatment of patients with brain metastases from GI malignancies in the modern radiosurgical and systemic therapy era. A review of patients treated with SRS to brain metastases from GI primaries treated from 1996 to 2015 at our institution was conducted. Clinical, therapeutic, dosimetric and radiographic characteristics were collected and analyzed for an association with brain tumor local control (LC) and overall survival (OS) following SRS using univariate and multivariate (MVA) analyses. 261 brain metastases were identified from 86 patients meeting inclusion criteria. The most common primary location was rectum (n = 36). LC was 94.1 % at last follow up and margin dose ≥20 Gy was associated with improved LC on MVA (p = 0.038). Median OS was 6.2 months and was improved with higher performance score and luminal primary location on MVA (p = 0.002 and 0.015, respectively). Tumor histology, whole brain irradiation, targeted therapies, and antineoplastic therapies were not associated with improved LC or OS on MVA. SRS provides favorable LC of brain metastases of GI origin, and margin doses of at least 20 Gy should be considered when clinically appropriate. Compared to non-luminal primaries, patients with brain metastases from a luminal primary demonstrate improved OS.
authors.affiliation: Department of Radiation Oncology, University of Virginia Health System, 1240 Lee Street, Box 800383, Charlottesville, VA, 22908, USA. daniel.trifiletti@gmail.com.
authors.forename: Daniel M
authors.identifier: http://orcid.org/0000-0002-9150-2916
authors.initials: DM
authors.lastname: Trifiletti
authors.affiliation: Department of Radiation Oncology, University of Virginia Health System, 1240 Lee Street, Box 800383, Charlottesville, VA, 22908, USA.
authors.forename: Nirav
authors.initials: N
authors.lastname: Patel
authors.affiliation: Department of Neurosurgery, Taipei Veteran General Hospital, Neurological Institute, Taipei, Taiwan, Roc.
authors.forename: Cheng-Chia
authors.initials: CC
authors.lastname: Lee
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, University of Virginia, Charlottesville, VA, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Romano
authors.affiliation: Department of Radiation Oncology, University of Virginia Health System, 1240 Lee Street, Box 800383, Charlottesville, VA, 22908, USA.|Department of Neurological Surgery, University of Virginia, Charlottesville, VA, USA.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Sheehan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000556:secondary* / Q000601:surgery*; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000473:pathology*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016634:Radiosurgery / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Brain; Gamma Knife; Gastrointestinal; Luminal; Metastasis; Radiosurgery