Abstract
ObjectiveThe objective of this study was to investigate outcomes for patients with brainstem metastases treated with stereotactic radiosurgery (SRS).MethodsPatients with brainstem metastases treated with SRS between April 2006 and June 2012 were identified from a prospective database. Patient and treatment-related factors were recorded. Kaplan-Meier analysis was used to calculate survival and freedom from local and distant brain progression. Univariate and multivariate Cox regression was used to identify factors important for overall survival.ResultsIn total, 44 patients received SRS for 48 brainstem metastases of whom 33 (75 %) also received whole brain radiotherapy (WBRT): 23 patients (52 %) WBRT prior to SRS, 6 (13.6 %) WBRT concurrently with SRS and 4 (9.0 %) WBRT after SRS. Eight patients received a second course of WBRT at further progression. Median target volume was 1.33 cc (range 0.04–12.17) and median prescribed marginal dose was 15 Gy (range 10–22). There were four cases of local failure, and 6-month and 1-year freedom from local failure was 84.6 and 76.9 %, respectively. Median overall survival (OS) was 5.4 months. There were four cases of radionecrosis, 2 (4.8 %) of which were symptomatic. The absence of external beam brain radiotherapy (predominantly WBRT) showed a trend towards improved OS on univariate analysis. Neither local nor distant brain failure significantly impacted OS.ConclusionThis retrospective series of patients treated with SRS for brainstem metastases, largely in combination with at least one course of WBRT, demonstrates that this approach is safe and results in good local control. In this cohort, no variables significantly impacted OS, including intracranial control.
Highlights
Between 20 and 40 % of patients with cancer develop brain metastases of which 2–5 % arise in the brainstem [1,2,3,4,5]
Neither local nor distant brain failure significantly impacted overall survival (OS). This retrospective series of patients treated with stereotactic radiosurgery (SRS) for brainstem metastases, largely in combination with at least one course of whole brain radiotherapy (WBRT), demonstrates that this approach is safe and results in good local control
While brainstem metastases represent a small proportion of brain metastases overall, these lesions are challenging in terms of management, and prognosis is traditionally poor
Summary
Between 20 and 40 % of patients with cancer develop brain metastases of which 2–5 % arise in the brainstem [1,2,3,4,5]. While brainstem metastases represent a small proportion of brain metastases overall, these lesions are challenging in terms of management, and prognosis is traditionally poor. Given the critical functions performed by the brainstem, surgery is not typically utilised, and the preferred treatment is with radiation, either with conventionally fractionated external beam radiotherapy or stereotactic radiosurgery (SRS). Radiosurgery is an established treatment modality for brain metastases, commonly offered when the metastases are limited in number and size (generally
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