Prognostic factors in patients treated with stereotactic image-guided robotic radiosurgery for brain metastases: a single-center retrospective analysis of 223 patients.
In this retrospective study, we evaluated the overall survival (OS) and local control (LC) of brain metastases (BM) in patients treated with stereotactic radiosurgery (SRS). The scope was to identify host, tumor, and treatment factors predictive of LC and survival and define implications for clinical decisions. A total of 223 patients with 360 BM from various histologies treated with SRS alone or associated with whole brain radiotherapy (WBRT) in our institution between July 1, 2008 and August 31, 2013 were retrospectively reviewed. Among other prognostic factors, we had also evaluated retrospectively Karnofsky performance status scores (KPS) and graded prognostic assessment (GPA). Overall survival (OS) and local control (LC) were the primary endpoints. Kaplan-Meier and Cox proportional hazards models were used to estimate OS and LC and identify factors predictive of survival and local control. The median duration of follow-up time was 9 months (range 0.4-51 months). Median overall survival of all patients was 11 months. The median local control was 38 months. No statistical difference in terms of survival or LC between patients treated with SRS alone or associated with WBRT was found. On multivariate analysis, KPS was the only statistically significant predictor of OS (hazard ratio [HR] 2.53, p = 0.006). On univariate analysis, KPS and GPA were significantly prognostic for survival. None of the host, tumor, or treatment factors analyzed in the univariate model factors were significantly associated with local failure.
Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy. apontoriero@unime.it.
Antonio
http://orcid.org/0000-0003-3011-6779
A
Pontoriero
Department of Neuroscience Messina, University of Messina, Messina, Italy.
Alfredo
A
Conti
Operative Unit of Radiation Oncology, A.O.U. "G. Martino", Via Consolare Valeria, 98100, Messina, Italy.
Giuseppe
G
Iatì
Department of Neuroscience Messina, University of Messina, Messina, Italy.
Stefania
S
Mondello
School of Medicine, Messina University, Messina, Italy.
Dario
D
Aiello
School of Medicine, Messina University, Messina, Italy.
Carmen
C
Rifatto
School of Medicine, Messina University, Messina, Italy.
Edoarda
E
Risoleti
School of Medicine, Messina University, Messina, Italy.
Micol
M
Mazzei
Department of Neuroscience Messina, University of Messina, Messina, Italy.
Francesco
F
Tomasello
Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy.
Stefano
S
Pergolizzi
Department of Biomedical Sciences and Morphological and Functional Images, University of Messina, Messina, Italy.
Costantino
C
De Renzis
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D017567:Karnofsky Performance Status / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models; D016634:Radiosurgery / Q000379:methods; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures
Brain metastases; Cyberknife; Prognostic factors; Radiosurgery