Long Term Survivors of Stereotactic Radiosurgery for Brain Metastases: Do Distant Brain Failures Reach a Plateau and What Factors Are Associated with a Brain Metastasis Velocity of Zero?
Year: 2022
Type: preprint
Study design: Observational Study
Abstract: Purpose Life expectancy continues to increase for patients with brain metastases treated with stereotactic radiosurgery (SRS). The present study sought to retrospectively analyze brain metastasis patients who have survived two years or more, and assess for what factors may predict for a final brain metastasis velocity (BMV) of zero. Methods This was a single-institution retrospective study of 300 patients treated with SRS from 2001 to 2019 for brain metastases who survived greater than two years after first SRS. Final BMV is calculated by summing all metastases through the observed time divided by the total time in years. A BMV of zero is defined as at least two years of imaging follow-up without distant brain failure (DBF). Results Median age at first SRS is 61 (IQR: 53, 70). Kaplan-Meier estimated median overall survival is 4.9 years and time to DBF is 1.5 years (95% CI: 1.2, 2.0). Twenty-eight (9.3%) patients underwent subsequent WBRT. One hundred and one (33.7%) patients never had any further brain metastases (BMV = 0) at a median follow-up time of 3.3 years. Median BMV is 0.4 (IQR: 0, 1.4). Distant brain failures reach a plateau at four years where the cumulative incidence of DBF is 82%. Seventy percent of first time DBFs have occurred by two years. Factors significantly associated with a BMV of zero include fewer brain metastases at first SRS (HR 1.1; p = 0.0004) and Caucasian race (HR 1.5; p = 0.03). Conclusion Approximately one third of brain metastasis patients who live beyond two years after initial SRS have a BMV of zero. DBFs appear to reach a plateau at four years. Factors significantly associated with a BMV of zero include Caucasian race and having had a single brain metastasis at first SRS.
Source: Research Square
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4295780291