Stereotactic radiosurgery in the management of non–small cell lung cancer brain metastases: a prospective study using the NeuroPoint Alliance Stereotactic Radiosurgery Registry

Author:

Michalopoulos Giorgos D.12,Katsos Konstantinos12,Grills Inga S.3,Warnick Ronald E.4,McInerney James5,Attia Albert6,Timmerman Robert7,Chang Eric8,Andrews David W.9,D’Ambrosio Anthony L.10,Cobb William S.10,Pouratian Nader7,Spalding Aaron C.11,Walter Kevin12,Jensen Randy L.13,Bydon Mohamad12,Asher Anthony L.14,Sheehan Jason P.15

Affiliation:

1. Neuro-Informatics Laboratory, and

2. Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota;

3. Department of Neurological Surgery, Beaumont Health System, Royal Oak, Michigan;

4. Department of Neurosurgery, The Jewish Hospital, Cincinnati, Ohio;

5. Department of Neurosurgery, Penn State Health, Hershey, Pennsylvania;

6. Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee;

7. Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, Texas;

8. Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California;

9. Department of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;

10. The Valley Hospital, Paramus, New Jersey;

11. Norton Cancer Institute, Norton Healthcare, Louisville, Kentucky;

12. Department of Neurosurgery, University of Rochester Medical Center, Rochester, New York;

13. Department of Neurosurgery, University of Utah, Salt Lake City, Utah;

14. Neuroscience Institute, Carolinas Healthcare System and Carolina Neurosurgery & Spine Associates, Charlotte, North Carolina; and

15. Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia

Abstract

OBJECTIVE The literature on non–small cell lung cancer (NSCLC) brain metastases (BMs) managed using stereotactic radiosurgery (SRS) relies mainly on single-institution studies or randomized controlled trials (RCTs). There is a literature gap on clinical and radiological outcomes of SRS for NSCLC metastases in real-world practice. The objective of this study was to benchmark mortality and progression outcomes in patients undergoing SRS for NSCLC BMs and identify risk factors for these outcomes using a national quality registry. METHODS The SRS Registry of the NeuroPoint Alliance was used for this study. This registry included patients from 16 enrolling sites who underwent SRS from 2017 to 2022. Data are prospectively collected without a prespecified research purpose. The main outcomes of this analysis were overall survival (OS), out-of-field recurrence, local progression, and intracranial progression. All time-to-event investigations included Kaplan-Meier analyses and multivariable Cox regressions. RESULTS Two hundred sixty-four patients were identified, with a mean age of 66.7 years and a female proportion of 48.5%. Most patients (84.5%) had a Karnofsky Performance Status (KPS) score of 80–100, and the mean baseline EQ-5D score was 0.539 quality-adjusted life years. A single lesion was present in 53.4% of the patients, and 29.1% of patients had 3 or more lesions. The median OS was 28.1 months, and independent predictors of mortality included no control of primary tumor (hazard ratio [HR] 2.1), KPS of 80 (HR 2.4) or lower (HR 2.4), coronary artery disease (HR 2.8), and 5 or more lesions present at the time of SRS treatment (HR 2.3). The median out-of-field progression-free survival (PFS) was 24.8 months, and the median local PFS was unreached. Intralesional hemorrhage was an independent risk factor of local progression, with an HR of 6.0. The median intracranial PFS was 14.0 months and was predicted by the number of lesions at the time of SRS (3–4 lesions, HR 2.2; 5–14 lesions, HR 2.5). CONCLUSIONS In this real-world prospective study, the authors used a national quality registry and found favorable OS in patients with NSCLC BMs undergoing SRS compared with results from previously published RCTs. The intracranial PFS was mainly driven by the emergence of new lesions rather than local progression. A greater number of lesions at baseline was associated with out-of-field progression, while intralesional hemorrhage at baseline was associated with local progression.

Publisher

Journal of Neurosurgery Publishing Group (JNSPG)

Subject

Genetics,Animal Science and Zoology

Reference41 articles.

1. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries;Sung H,2021

2. Brain metastases;Gállego Pérez-Larraya J,2014

3. The economic burden of brain metastasis among lung cancer patients in the United States;Guérin A,2016

4. Treatment for brain metastases: ASCO-SNO-ASTRO guideline;Vogelbaum MA,2022

5. Real-world evidence-what does it really mean?;Nabhan C,2019

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