Central Nervous System

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MO_13_2801 - Effectiveness of Repeat Courses of Stereotactic Radiosurgery in Patients with Brain Metastases: A Single Institution Experience

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Effectiveness of Repeat Courses of Stereotactic Radiosurgery in Patients with Brain Metastases: A Single Institution Experience
S. Vanderkelen1, A. Saraf2, C. C. Wu2, M. Hwang2, C. H. Tai2, C. S. Grubb2, M. E. Lapa2, J. I. S. Andrews2, A. Jani2, S. R. Isaacson3, S. K. Cheng4, and T. J. C. Wang2; 1Columbia University College of Physicians and Surgeons, New York, NY, 2Department of Radiation Oncology, Columbia University Medical Center, New York, NY, 3Department of Neurological Surgery, Columbia University Medical Center, New York, NY, 4Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY

Purpose/Objective(s): Management of multiple brain metastases (BM) is evolving as treatment options expand beyond whole brain radiotherapy (WBRT). Repeat courses of SRS (reSRS) is an appealing option for patients, however long-term outcome data is lacking. Our study looks at the feasibility and effectiveness of treating patients with reSRS.

Materials/Methods: From November 2000 to May 2016, we evaluated all patients with BM with Gamma Knife stereotactic radiosurgery at a single institution. Local and distant brain failures were assessed by reviewing follow up brain imaging and radiology reports. In-field local tumor failure was defined as an increase of 20 % in tumor volume. Progression-free survival (PFS) was defined as date of SRS treatment to date of next SRS treatment. Overall survival (OS) was defined as date of first SRS treatment to last known follow-up. Cox proportion hazard models were used to evaluate the associated risk factors for development BM.

Results: 124 patients were identified that underwent reSRS. Patients treated with reSRS received a range of 2 to 6 courses of SRS. The median age was 63 years old with a median follow up time of 9.2 months. The median time from the 1st SRS treatment to failure was 5.4 months, whereas median time from reSRS to failure was 4.6 months (NS). The median OS for reSRS was 11.5 months and was non-inferior to single SRS (HR 1.670, p=0.026) and single SRS then WBRT (HR: 1.681, p=0.000). Radiation necrosis developed in 4 patients (3.2%) after 1st course of SRS, and in 1 patient (0.8%) after subsequent repeat courses of SRS. Leptomeningeal disease was evident in 5 patients (4%) after 1st course of SRS, and in 5 patients (4%) in subsequent repeat courses of SRS. Univariate analysis found for OS in patients with re-SRS, aggregate tumor volume greater than 0.4 cm3 (HR 2.88), number of lesions greater than 3 (HR 1.84) and original tumor type of melanoma (HR 2.27) were statistically significant. Multivariate analysis showed that tumor volume greater than 0.4 cm3 was significant (HR 2.32).

Conclusion: Patients with BM who received reSRS had insignificant differences in PFS and OS. Rates of radiation necrosis and leptomeningeal disease were comparable between first course of SRS and reSRS. OS in patients with reSRS was associated with aggregate tumor volume. ReSRS is a viable option for patients with multiple BM.

Author Disclosure: S. Vanderkelen: None. A. Saraf: None. C. Wu: None. C. Tai: None. C.S. Grubb: None. M.E. Lapa: None. J.I. Andrews: None. A. Jani: None. S.R. Isaacson: None. T.J. Wang: Honoraria; Elekta, Wolthers Kluwer. Consultant; Abbvie, Merck, Doximity, Elekta. Advisory Board; American Cancer Society North Jersey, AstraZeneca. Travel Expenses; Abbvie, AstraZeneca, Elekta. Stock Options; Doximity.

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