title: Control of brain metastases from radioresistant tumors treated by stereotactic radiosurgery.
abstract: Renal cell carcinoma, sarcoma, and melanoma are considered to be "radioresistant" tumor histologies. Brain metastases (BM) from these tumors are considered unlikely to be controlled using the relatively low doses used in whole brain radiotherapy (WBRT). Our objective was to analyze the efficacy of stereotactic radiosurgery (SRS) on local control and overall survival of BM from radioresistant primary tumors. We reviewed all patients who received Gamma Knife Radiosurgery (GKRS) for BM at Columbia University Medical Center between January 2009 and April 2014. All patients were treated using the Gamma Knife Perfexion System. Dosimetric data was collected from treatment plans and metastases were categorized as radioresistant or not. Response was assessed by reviewing follow-up brain imaging studies and classified according to RECIST. Local control and median overall survival were calculated using the Kaplan-Meier method. In total, 373 tumors were analyzed from 126 patients. Of these tumors, 49 (13.1 %) originated from radioresistant cancers. The overall local control rate in the radioresistant cohort was 89.8 and 90.1 % in the non-radioresistant cohort. Univariate and multivariate analyses demonstrated that radioresistance status of the primary tumor had no statistically significant effect on local control with hazard ratios of 1.0 (p = 1.0, 95 % CI 0.388-2.576) and 0.954 (p = 0.926, 95 % CI 0.349-2.603) respectively. Median overall survival for both radioresistant and non-radioresistant cohorts was 20.0 months, with a p value of 0.926. There was no significant difference in local control of BM from radioresistant and non-radioresistant primary tumors treated with GKRS. Both cohorts showed excellent response and local control, suggesting that SRS upfront or in addition to WBRT may be an appropriate strategy in the treatment of BM from radioresistant cancers. Median overall survival for both cohorts was equal, suggesting that improved local control may be associated with an improvement in long-term survival.
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, 622 West 168th Street, BNH B-11, New York, NY, 10032, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Yaeh
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, 622 West 168th Street, BNH B-11, New York, NY, 10032, USA.
authors.forename: Tavish
authors.initials: T
authors.lastname: Nanda
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, 622 West 168th Street, BNH B-11, New York, NY, 10032, USA.
authors.forename: Ashish
authors.initials: A
authors.lastname: Jani
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, 622 West 168th Street, BNH B-11, New York, NY, 10032, USA.
authors.forename: Tzlil
authors.initials: T
authors.lastname: Rozenblat
authors.affiliation: The Taub Institute for Research on Alzheimer's Disease and the Aging, Columbia University Medical Center, New York, NY, 10032, USA.
authors.forename: Yasir
authors.initials: Y
authors.lastname: Qureshi
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, 622 West 168th Street, BNH B-11, New York, NY, 10032, USA.
authors.forename: Shumaila
authors.initials: S
authors.lastname: Saad
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, 622 West 168th Street, BNH B-11, New York, NY, 10032, USA.
authors.forename: Jeraldine
authors.initials: J
authors.lastname: Lesser
authors.affiliation: Department of Neurology, Columbia University Medical Center, New York, NY, 10032, USA.|Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, 10032, USA.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Lassman
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, 622 West 168th Street, BNH B-11, New York, NY, 10032, USA.|Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, 10032, USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Isaacson
authors.affiliation: Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, 10032, USA.|Department of Neurological Surgery, Columbia University Medical Center, New York, NY, 10032, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Sisti
authors.affiliation: Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, 10032, USA.|Department of Neurological Surgery, Columbia University Medical Center, New York, NY, 10032, USA.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Bruce
authors.affiliation: Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, 10032, USA.|Department of Neurological Surgery, Columbia University Medical Center, New York, NY, 10032, USA.
authors.forename: Guy M
authors.initials: GM
authors.lastname: McKhann
authors.affiliation: Department of Radiation Oncology, Columbia University Medical Center, 622 West 168th Street, BNH B-11, New York, NY, 10032, USA. tjw2117@cumc.columbia.edu.|Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, 10032, USA. tjw2117@cumc.columbia.edu.
authors.forename: Tony J C
authors.initials: TJ
authors.lastname: Wang
mesh_terms: D001932:Brain Neoplasms / Q000556:secondary / Q000601:surgery*; D015331:Cohort Studies; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D016634:Radiosurgery / Q000379:methods*; D016896:Treatment Outcome
keywords: Brain metastases; Gamma knife radiosurgery; Local control; Radioresistance