Multi-institutional Outcomes after Stereotactic Radiosurgery for Gastrointestinal Brain Metastases

Area of Science:

• Neuro-oncology
• Radiation Oncology
• Gastrointestinal Oncology

Background:

• Brain metastases are a common complication of various cancers.
• Stereotactic radiosurgery (SRS) is a key treatment modality for brain metastases.
• Outcomes for patients with gastrointestinal (GI) primary cancers and brain metastases after SRS are not well-defined.

Purpose of the Study:

• To compare treatment outcomes between patients with gastrointestinal (GI) versus nongastrointestinal (non-GI) brain metastases treated with SRS.
• To identify factors influencing survival and progression in these patient groups.

Main Methods:

• Retrospective cohort study of 1383 patients (102 GI, 1281 non-GI) undergoing SRS between 2015-2020.
• Primary outcomes: overall survival (OS) and intracranial progression-free survival (PFS).
• Statistical analysis included Kaplan-Meier and Cox proportional hazard models.

Main Results:

• GI patients were younger, more likely male, received more systemic therapy, and underwent resection of brain metastases prior to SRS.
• Median OS was significantly lower for GI patients (5.4 months) vs. non-GI patients (10.6 months) (P < 0.0001).
• Median intracranial PFS was significantly lower for GI patients (6.2 months) vs. non-GI patients (12.3 months) (P = 0.0002).

Conclusions:

• Brain metastases originating from GI cancers demonstrate inferior overall survival and intracranial progression-free survival following SRS compared to non-GI origins.
• These findings underscore a need for tailored treatment strategies and surveillance protocols for GI cancer patients with brain metastases.
• No significant outcome differences were observed between colorectal or esophageal primary GI cancers versus other GI sites.