Clinical and volumetric predictors of local control after robotic stereotactic radiosurgery for cerebral metastases: active systemic disease may affect local control in the brain

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| 10 nov 2020

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	Median (range)
Age	58 (32–84)
KPS	80 (70–100)
Number of lesions (1-9)	1 (1–9)
	Number of patients
1	40
2	12
3
4
5
6
9
Gender (M/F)	22/47
WBRT before SRS
Yes	34
No	35
Location of the primary tumour
Lung	23
Breast	20
Kidney
Skin (melanoma)
Colon
Unknown primary
Uterine corpus
Other = One case of each: intestinal sarcoma, thyroid cancer, uterine cervix carcinoma, esophageal, gastric, oral cavity, ovarian, and bladder cancer; F = female; KPS = Karnofsky performance status; M = male; NED = no evidence of disease; SRS = stereotactic radiosurgery; WBRT = whole brain radiotherapy
Disease status
Stable/NED	42
Progressive	27
Primary tumor controlled
Yes	62
No	7
Extracranial metastases
Present	39
No	30

Variable	Median (range)	p
Total dose in SRS	18 Gy (5–24)	p = 0.0036 = comparison between groups, Mann-Whitney U test; BED₁₀ = biologically effective dose for alpha/ beta =10; HSRT = hypofractionated stereotactic radiotherapy; SRS – stereotactic radiosurgery
Total dose in HSRT	20 Gy (12–30)
Dose per fraction in HSRT	7.25 Gy (6–13 )
BED₁₀ in SRS	50.4 (7.5–81.6)	p = 0.0237 = comparison between groups, Mann-Whitney U test; BED₁₀ = biologically effective dose for alpha/ beta =10; HSRT = hypofractionated stereotactic radiotherapy; SRS – stereotactic radiosurgery
BED₁₀ in HSRT	35.7 (19.2–60)
Lesion volume	1.74 cm³ (0.001–46.99)
Single metastasis	4.68 cm³ (0.05–39.2)	p = 0.0002 = comparison between groups, Mann-Whitney U test; BED₁₀ = biologically effective dose for alpha/ beta =10; HSRT = hypofractionated stereotactic radiotherapy; SRS – stereotactic radiosurgery
Multiple metastases	0.96 cm3 (0.001–46.99)
Total tumor volume	4.9 cm³ (0.05–63.95)
Single metastasis volume	4.68 cm³ (0.05–39.2)	p = 0.0371 = comparison between groups, Mann-Whitney U test; BED₁₀ = biologically effective dose for alpha/ beta =10; HSRT = hypofractionated stereotactic radiotherapy; SRS – stereotactic radiosurgery
Multiple metastases volume	4.90 cm³ (0.48–63.95)

	p
Variable	univariate	Multivariate
Single vs. multiple lesions	0.00001	0.0161
Gender	0.2508
Total dose = above vs. below or equal median;	0.0011	0.0886
BED₁₀ = above vs. below or equal median;	0.7026
BED₁₀ > 59 Gy	0.0026	0.0105
Fractionation (SRS vs. HSRT)	0.1265
Tumor volume^¶	0.1777
Total tumor volume^¶	0.8950
Chemotherapy before SRS/HSRT	0.3785
Chemotherapy after SRS/HSRT	0.2174
Chemotherapy before and after SRS/HSRT	0.2606
Time between diagnosis of primary and metastases = above vs. below or equal median;	0.6551
BED₁₀ per 1 ml tumor volume > median (24.3 Gy)	0.3709
BED₁₀ per 1 ml tumor volume > 36 Gy	0.0281	0.3032
Total dose/ml tumor volume > median (11 Gy)	0.3882
Extracranial metastases	0.3130
Control of primary tumor	0.8681
Extracranial progression = progression of primary tumor or any of extracranial metastases; SRS = stereotactic radiosurgery; HSRT = hypofractionated stereotactic radiotherapy; BED₁₀, BED_{2 =} biologically effective dose for alpha/beta =10 and 2, respectively; WBRT = whole brain radiotherapy; RPA = recursive partitioning analysis	0.0078	0.0011
RPA class	0.8627
WBRT use	0.3918
BED₂/cm³ > 60	0.0392	0.8638

Calendario de la edición:: 4 veces al año
Temas de la revista:: Medicine, Clinical Medicine, Internal Medicine, Haematology, Oncology, Radiology