Stereotactic radiosurgery for large brain metastases.

Area of Science:

• Neurosurgery
• Radiation Oncology
• Oncology

Background:

• Stereotactic radiosurgery (SRS) is effective for limited brain metastases.
• Large brain metastases (≥3 cm) present unique challenges for SRS treatment.
• Evaluating outcomes for large brain metastases treated with SRS is crucial.

Purpose of the Study:

• To assess patient outcomes after SRS for large brain metastases (≥3 cm).
• To compare local control and survival rates for large versus smaller brain metastases treated with SRS.
• To identify factors influencing local control and survival in patients with large brain metastases.

Main Methods:

• Retrospective analysis of 343 patients with 754 brain metastases treated with SRS.
• Focus on 93 patients with large brain metastases (≥3 cm).
• Analysis included local control, overall survival, and factors like prior surgery, tumor size, and SRS dose.

Main Results:

• One-year local control was 68% for large metastases versus 86% for smaller ones (p<0.001).
• No correlation found between local control and surgical resection, extent of surgery, histology, tumor size, or SRS dose in large metastases.
• Overall survival at 1, 2, and 5 years was 46%, 29%, and 5%, respectively. Younger age (<65), primary treatment, and controlled primary tumors correlated with prolonged survival.
• Radiation necrosis occurred in 11.8% of patients with large metastases.

Conclusions:

• SRS for large brain metastases is well-tolerated and can achieve CNS disease control and survival benefits in some patients.
• Local control rates for large brain metastases treated with SRS are suboptimal compared to smaller lesions.
• Further research and novel strategies are necessary to improve treatment outcomes for patients with large brain metastases.