Abstract
BackgroundTo analyze the tumor control, survival outcomes, and toxicity after stereotactic radiosurgery (SRS) for skull base metastases from systemic cancer involving the anterior visual pathway.Patients and methodsWe have analyzed 34 patients (23 females and 11 males, median age 59 years) who underwent multi-fraction SRS for a skull base metastasis compressing or in close proximity of optic nerves and chiasm. All metastases were treated with frameless LINAC-based multi-fraction SRS in 5 daily fractions of 5 Gy each. Local control, distant failure, and overall survival were estimated using the Kaplan-Meier method calculated from the time of SRS. Prognostic variables were assessed using log-rank and Cox regression analyses.ResultsAt a median follow-up of 13 months (range, 2–36.5 months), twenty-five patients had died and 9 were alive. The 1-year and 2-year local control rates were 89% and 72%, and respective actuarial survival rates were 63% and 30%. Four patients recurred with a median time to progression of 12 months (range, 6–27 months), and 17 patients had new brain metastases at distant brain sites. The 1-year and 2-year distant failure rates were 50% and 77%, respectively. On multivariate analysis, a Karnofsky performance status (KPS) >70 and the absence of extracranial metastases were prognostic factors associated with lower distant failure rates and longer survival. After multi-fraction SRS, 15 (51%) out of 29 patients had a clinical improvement of their preexisting cranial deficits. No patients developed radiation-induced optic neuropathy during the follow-up.ConclusionsMulti-fraction SRS (5 x 5 Gy) is a safe treatment option associated with good local control and improved cranial nerve symptoms for patients with a skull base metastasis involving the anterior visual pathway.
Highlights
The base of the skull is a less common site of metastases; they represent a clinical challenge as growing lesions in such area that compress optic nerve, chiasm, and nerves involved in the extraocular movement have been associated with serious morbidity [1]
A Karnofsky performance status (KPS) >70 and the absence of extracranial metastases were prognostic factors associated with lower distant failure rates and longer survival
Multi-fraction stereotactic radiosurgery (SRS) (5 x 5 Gy) is a safe treatment option associated with good local control and improved cranial nerve symptoms for patients with a skull base metastasis involving the anterior visual pathway
Summary
The base of the skull is a less common site of metastases; they represent a clinical challenge as growing lesions in such area that compress optic nerve, chiasm, and nerves involved in the extraocular movement have been associated with serious morbidity [1]. Stereotactic radiosurgery (SRS), which has been used for nearly 30 years in patients with a limited number of brain metastases, is an effective treatment associated with excellent local control without compromising survival, and potentially avoiding the risk of the detrimental neurocognitive effects of WBRT [12,13]. Multifraction SRS (up to 5 fractions) has been employed in patients with brain metastases as an alternative to singlefraction SRS with the aim to reduce late radiation-induced toxicity while maintaining high local control rate. In patients with brain metastases multi-fraction SRS at doses of 27–42 Gy in 3–5 fractions has resulted in 1-year local control of 70-90% with acceptable radiation-induced toxicity [21,22,23,24,25], the efficacy and safety of this approach in patients with a skull base metastasis remains to be determined. To analyze the tumor control, survival outcomes, and toxicity after stereotactic radiosurgery (SRS) for skull base metastases from systemic cancer involving the anterior visual pathway
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