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Nature communications
May 02, 2024;15 (1): 3728.

Response of treatment-naive brain metastases to stereotactic radiosurgery.

Chibawanye I Ene, Christina Abi Faraj, Thomas H Beckham, Jeffrey S Weinberg, Clark R Andersen, Ali S Haider, Ganesh Rao, Sherise D Ferguson, Christopher A Alvarez-Brenkenridge, Betty Y S Kim, Amy B Heimberger, Ian E McCutcheon, Sujit S Prabhu, Chenyang Michael Wang, Amol J Ghia, Susan L McGovern, Caroline Chung, Mary Frances McAleer, Martin C Tom, Subha Perni, Todd A Swanson, Debra N Yeboa, Tina M Briere, Jason T Huse, Gregory N Fuller, Frederick F Lang, Jing Li, Dima Suki, Raymond E Sawaya
Author Information
  1. Chibawanye I Ene: Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA. cene@mdanderson.org. ORCID
  2. Christina Abi Faraj: Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA.
  3. Thomas H Beckham: Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA.
  4. Jeffrey S Weinberg: Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA. ORCID
  5. Clark R Andersen: Department of Biostatistics, The University of Texas M D Anderson Cancer Center, Houston, TX, USA.
  6. Ali S Haider: Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA.
  7. Ganesh Rao: Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
  8. Sherise D Ferguson: Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA.
  9. Christopher A Alvarez-Brenkenridge: Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA.
  10. Betty Y S Kim: Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA. ORCID
  11. Amy B Heimberger: Department of Neurological Surgery, Malnati Brain Tumor Institute of the Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. ORCID
  12. Ian E McCutcheon: Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA. ORCID
  13. Sujit S Prabhu: Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA.
  14. Chenyang Michael Wang: Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA.
  15. Amol J Ghia: Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA.
  16. Susan L McGovern: Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA.
  17. Caroline Chung: Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA.
  18. Mary Frances McAleer: Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA.
  19. Martin C Tom: Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA.
  20. Subha Perni: Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA.
  21. Todd A Swanson: Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA.
  22. Debra N Yeboa: Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA.
  23. Tina M Briere: Department of Radiation Physics, Division of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA.
  24. Jason T Huse: Department of Pathology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA.
  25. Gregory N Fuller: Department of Pathology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA. ORCID
  26. Frederick F Lang: Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA. ORCID
  27. Jing Li: Department of Radiation Oncology, The University of Texas M D Anderson Cancer Center, Houston, TX, USA.
  28. Dima Suki: Department of Neurosurgery, The University of Texas M D Anderson Cancer Center, Houston, TX, USA.
  29. Raymond E Sawaya: Faculty of Medicine and Medical Affairs, American University of Beirut, Beirut, Lebanon.
PMID: 38697991 DOI: 10.1038/s41467-024-47998-8

Abstract

With improvements in survival for patients with metastatic cancer, long-term local control of brain metastases has become an increasingly important clinical priority. While consensus guidelines recommend surgery followed by stereotactic radiosurgery (SRS) for lesions >3 cm, smaller lesions (≤3 cm) treated with SRS alone elicit variable responses. To determine factors influencing this variable response to SRS, we analyzed outcomes of brain metastases ≤3 cm diameter in patients with no prior systemic therapy treated with frame-based single-fraction SRS. Following SRS, 259 out of 1733 (15%) treated lesions demonstrated MRI findings concerning for local treatment failure (LTF), of which 202 /1733 (12%) demonstrated LTF and 54/1733 (3%) had an adverse radiation effect. Multivariate analysis demonstrated tumor size (>1.5 cm) and melanoma histology were associated with higher LTF rates. Our results demonstrate that brain metastases ≤3 cm are not uniformly responsive to SRS and suggest that prospective studies to evaluate the effect of SRS alone or in combination with surgery on brain metastases ≤3 cm matched by tumor size and histology are warranted. These studies will help establish multi-disciplinary treatment guidelines that improve local control while minimizing radiation necrosis during treatment of brain metastasis ≤3 cm.

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MeSH Term

Radiosurgery
Humans
Brain Neoplasms
Male
Female
Middle Aged
Aged
Magnetic Resonance Imaging
Melanoma
Adult
Treatment Outcome
Tumor Burden
Aged, 80 and over
Treatment Failure
Retrospective Studies
Journal Article Research Support, Non-U.S. Gov't Research Support, N.I.H., Extramural

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