Purpose/Objective(s): To prospectively analyze quality of life, recurrence patterns, and survival after adjuvant stereotactic radiosurgery (SRS) for resected brain metastases.

Materials/Methods: We analyzed the outcomes of 152 resected brain metastases from 148 patients who underwent surgical resection (R) followed by adjuvant SRS to a median marginal dose of 16 Gy (range 11-18 Gy) to the 50% isodose (range 35-80%) at a single institution with a minimum of 6 mos follow-up. We analyzed factors affecting local failure (LF), elsewhere brain failure, (EBF) leptomeningeal failure (LMF), cancer-specific survival (CSS), freedom from neurologic death (FND), and overall survival (OS). The EORTC QLQ-C30 was administered at enrollment and at 3 month intervals on a voluntary basis. A >=10% difference in scores was used as a clinically significant threshold. Survival and recurrence outcomes were analyzed according to Kaplan Meier.

Results: The median patient age was 60.4y (62% < 65 y, 48% >= 65 y), 40% male, 60% female. Primary tumor types were 54% lung, 16% breast, 7% melanoma, 6% colorectal, 4% renal cell, and 10% other. RPA class was I for 20%, II for 76%, and III for 4%. 66% of primary tumors were controlled, 33% uncontrolled (1% unknown). Extracranial metastases were present in 54%, absent in 45% of cases, and unknown in 1%. 46% had SRS to synchronous intact lesions. 83% had gross total resection (GTR); 16% subtotal resection (STR). The mean pre-R max tumor dimension was 3.2 cm (range 0.9-8 cm).The median time from R to SRS was 27.4 days (7-125 d): SRS was within 4 weeks of R in 62% and > 4 weeks from R in 38%. The median follow up from R/SRS was 1.75/1.68 y. Survival and recurrence outcomes are shown in Table 1. Median OS was 1.36 y. 1 and 2y OS were 61% and 36%. The 1 and 2y CSS were 76% and 45%. The 1 and 2y FND were 93% and 86%. 1 and 2y LF were 15% and 30% ; while LMF was 16% and 29%, respectively. 27% of patients had EBF at 6 mos, 48% by 1 y. QOL assessments were completed by 62% of patients. Of these, 40% also had 3-month QOL data available. Rates of dyspnea, appetite loss, and hair loss increased significantly at 3 mos. Global health status and all other QOL endpoints were maintained at 3 mos post-SRS. Univariate analysis of factors predicting LF, EBF, LMF and OS was performed. LC was higher for those with GTR than STR (75% vs 43% at 2 y). Longer time from R to SRS (<4 vs >= 4 w), the presence of extracranial metastases, and uncontrolled primary were associated with higher EBF, the latter two factors also predict lower OS. No factors significantly predicted for LMF.

Conclusion: These data demonstrated a maintenance of global health status and nearly all QOL endpoints following adjuvant SRS for resected brain metastases, supporting its use as an adjuvant therapy. LF and LMF rates were similar to or lower than those reported in recent randomized trials of postoperative SRS with a low rate of neurological death. Table 1

	6 m	1 y	2 y
OS (%)	79	61	36
CSS (%)	86	76	45
FND (%)	97	93	86
LF (%)	7	15	30
LMF (%)	8	16	29
EBF (%)	27	48	63