title: Patients with Long-Term Control of Systemic Disease Are a Favorable Prognostic Group for Treatment of Brain Metastases with Stereotactic Radiosurgery Alone.
abstract: BACKGROUND
  Stereotactic radiosurgery (SRS) alone is an attractive option for treatment of brain metastases. SRS avoids whole-brain radiotherapy (WBRT)-associated morbidity, but is limited by regional central nervous system (CNS) failures and short survival in some patients. We evaluated a subgroup of patients with controlled systemic disease that could represent a favorable patient population for SRS alone.
  
  
  METHODS
  All patients with brain metastases treated with SRS without WBRT at our institution between 2004 and 2014 were grouped into two cohorts: those with controlled systemic disease (CSD) for 1 year or longer before prior to presentation with brain metastases and those without (i.e., uncontrolled systemic disease [USD]). Rates of local and regional CNS failure, and overall survival were assessed with χ2and Student t tests. Cox regression analysis was performed to evaluate independent predictors of regional control and overall survival.
  
  
  RESULTS
  Two hundred ninety-four patients underwent SRS to 697 lesions, of which 65 patients had CSD. Median follow-up was 9.7 months. There was no difference in local control between the two cohorts (P = 0.795). Regional CNS control was significantly better for patients with CSD (68% vs. 48%; P = 0.001). Overall survival at 1 and 5 years for CSD were 65% and 13% with USD yielding 41% and 7%, respectively (P < 0.001). Multivariate analysis demonstrated that USD (relative CSD) independently predicts regional failure (hazard ratio [HR], 1.75; P = 0.008) and shorter overall survival (HR, 1.55; P = 0.007).
  
  
  CONCLUSIONS
  Patients with brain metastases after 1 year or longer of primary and systemic disease control represent a particularly favorable cohort, with lower regional CNS failure and prolonged survival, for an approach of SRS alone.
authors.affiliation: Department of Radiation Oncology, Rhode Island Hospital-Brown University Alpert Medical School, Providence, Rhode Island, USA.
authors.forename: Daniel K
authors.initials: DK
authors.lastname: Ebner
authors.affiliation: Department of Radiation Oncology, Rhode Island Hospital-Brown University Alpert Medical School, Providence, Rhode Island, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Gorovets
authors.affiliation: Department of Radiation Oncology, UMass Memorial Medical Center, Worcester, Massachusetts, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Rava
authors.affiliation: Department of Neurosurgery, Rhode Island Hospital-Brown University Alpert Medical School, Providence, Rhode Island, USA.
authors.forename: Deus
authors.initials: D
authors.lastname: Cielo
authors.affiliation: Department of Radiation Oncology, Rhode Island Hospital-Brown University Alpert Medical School, Providence, Rhode Island, USA.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Kinsella
authors.affiliation: Department of Radiation Oncology, Rhode Island Hospital-Brown University Alpert Medical School, Providence, Rhode Island, USA; Department of Radiation Oncology, Tufts Medical Center, Boston, Massachusetts, USA.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: DiPetrillo
authors.affiliation: Department of Radiation Oncology, Rhode Island Hospital-Brown University Alpert Medical School, Providence, Rhode Island, USA; Department of Radiation Oncology, Tufts Medical Center, Boston, Massachusetts, USA. Electronic address: jhepel@lifespan.org.
authors.forename: Jaroslaw T
authors.initials: JT
authors.lastname: Hepel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy* / Q000556:secondary; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016634:Radiosurgery / Q000379:methods* / Q000639:trends; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: Brain metastasis; Gamma knife; Primary disease control; Stereotactic radiosurgery; Systemic disease control