title: Management patterns of patients with cerebral metastases who underwent multiple stereotactic radiosurgeries.
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).
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, USA.
authors.forename: Deborah C
authors.initials: DC
authors.lastname: Marshall
authors.affiliation: Los Angeles Medical Center, University of California, Los Angeles, USA.
authors.forename: Logan P
authors.initials: LP
authors.lastname: Marcus
authors.affiliation: Wake Forest Baptist Health, Winston-Salem, USA.
authors.forename: Teddy E
authors.initials: TE
authors.lastname: Kim
authors.affiliation: Mayo School of Graduate Medical Education, Rochester, USA.
authors.forename: Brandon A
authors.initials: BA
authors.lastname: McCutcheon
authors.affiliation: San Diego Gamma Knife Center, San Diego, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Goetsch
authors.affiliation: Katsuta Hospital Mito GammaHouse, Hitachi-Naka, Japan.
authors.forename: Takao
authors.initials: T
authors.lastname: Koiso
authors.affiliation: 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.
authors.forename: John F
authors.initials: JF
authors.lastname: Alksne
authors.affiliation: San Diego Gamma Knife Center, San Diego, USA.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Ott
authors.affiliation: 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.
authors.forename: Bob S
authors.initials: BS
authors.lastname: Carter
authors.affiliation: Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, USA.
authors.forename: Jona A
authors.initials: JA
authors.lastname: Hattangadi-Gluth
authors.affiliation: Katsuta Hospital Mito GammaHouse, Hitachi-Naka, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Yamamoto
authors.affiliation: 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. clarkchen@ucsd.edu.
authors.forename: Clark C
authors.initials: CC
authors.lastname: Chen
mesh_terms: D000367:Age Factors; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000528:radiation effects; D001932:Brain Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy* / Q000556:secondary*; D019468:Disease Management; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D016634:Radiosurgery; D019233:Retreatment; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D047368:Tumor Burden
keywords: Brain metastasis; Gamma knife surgery; Repeat treatment; Stereotactic radiosurgery