Medical student University of Pittsburgh Medical Center Pittsburgh, Pennsylvania, United States
Introduction: Outcomes after stereotactic radiosurgery (SRS) for patients with brain metastases from gastrointestinal (GI) cancers have been rarely published. The authors present the largest known single-institution experience of patients with brain metastases from GI primaries treated with SRS.
Methods: Patients with brain metastases from GI primaries treated with SRS from 2000 – 2022 at the University of Pittsburgh Medical Center were reviewed. Primary outcomes were local tumor control (LTC) and overall survival (OS) with secondary endpoints of distant tumor progression and adverse radiation effects (ARE). Univariate and multivariate analysis were conducted for prognostic factors.
Results: We identified 214 eligible patients (30.4 % female; median age, 64.5 years; median KPS, 80) with 866 brain metastases. The most frequent primary sites were colon (36.9%), esophagus (27.6%), and rectal (12.2%). The median OS after SRS was 7 months with 1- and 2- year OS of 32.6% and 15.0% respectively. On univariate analysis, age > 65 (p = 0.02), and the presence of active systemic disease (p = 0.04) were associated with inferior OS. All factors were significant on multivariate analysis. At the last clinical follow up, 192 out of 214 (89.7%) patients had SRS treated tumor successfully controlled. Age > 65 (p = 0.02), number of brain metastases > 2 (p = 0.01), and cumulative tumor volume > 8.1 cc (p = 0.02) were associated with inferior LTC. The distant tumor progression rate was 21.9%. The incidence of ARE was 10%. The cause of death in these patients was progressive systemic disease in 70% patients, intracranial disease progression in 6.3% patients, and a combination of both in 23.7% patients.
Conclusion : SRS provided local brain tumor control in 89.7% of patients with stage IV metastatic GI cancers. In the future more effective systemic treatment options may improve overall survivals in patients with this advanced cancer.
