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Initial brain metastasis velocity: does the rate at which cancers first seed the brain affect outcomes?

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Abstract

Purpose/objective(s)

Brain metastasis velocity (BMV) is a metric that describes the rate of development of new brain metastases (BM) after initial stereotactic radiosurgery (SRS). A limitation in the application of BMV is it cannot be applied until time of first BM failure after SRS. We developed initial BM velocity (iBMV), a new metric that accounts for the number of BM at first SRS and the time since initial cancer diagnosis.

Materials/methods

We reviewed patients with BM treated at our institution with upfront SRS without WBRT. iBMV was calculated as the number of BM at initial SRS divided by time (years) from initial cancer diagnosis to first SRS. We performed a linear regression to correlate BMV as a continuous variable and with low, intermediate, and high BMV risk groups. Kaplan–Meier estimation of OS was calculated from time of first SRS to death. iBMV was not calculated for patients who presented with BM at initial cancer diagnosis.

Results

994 patients were treated with upfront SRS without WBRT between 2000 and 2017. Median OS was 8.5 mos. 595 (60%) patients developed BM after cancer diagnosis and median time to first SRS from time of initial diagnosis was 2.2 years. Median iBMV was 0.79 BM/year. iBMV correlated with BMV (β = 1.57 p = 0.021) and independently predicted for mortality [Cox proportional hazard ratio (HR) 1.11, p = 0.036] after accounting for histology, number of initial brain metastases (HR 1.03, p = 0.32), time from cancer diagnosis to SRS (HR 0.98, p = 0.157) in a multivariate model.

Conclusion

iBMV correlates with BMV and OS. With further validation, iBMV could serve as a metric to risk stratify patients for WBRT or SRS at time of first BM presentation.

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Authors and Affiliations

  1. Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA

    Michael H. Soike, Emory R. McTyre, Ryan T. Hughes, Michael Farris, Christina K. Cramer, Michael C. LeCompte, Claire M. Lanier, J. Daniel Bourland, Michael T. Munley & Michael D. Chan

  2. Department of Medicine (Hematology & Oncology), Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA

    Jimmy Ruiz

  3. Department of Diagnostic Radiology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA

    Jing Su

  4. Department of Cancer Biology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA

    Kounosuke Watabe

  5. Department of Pathology, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA

    Stacey O’Neill

  6. Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, NC, 27157, USA

    Adrian W. Laxton & Stephen B. Tatter

  7. Department of Radiation Oncology, Wake Forest Baptist Medical Center, Winston-Salem, NC, 27103, USA

    Michael H. Soike

Authors
  1. Michael H. Soike
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  2. Emory R. McTyre
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  3. Ryan T. Hughes
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  4. Michael Farris
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  5. Christina K. Cramer
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  6. Michael C. LeCompte
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  7. Claire M. Lanier
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  8. Jimmy Ruiz
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  9. Jing Su
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  10. Kounosuke Watabe
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  11. J. Daniel Bourland
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  12. Michael T. Munley
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  13. Stacey O’Neill
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  14. Adrian W. Laxton
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  15. Stephen B. Tatter
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  16. Michael D. Chan
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Corresponding author

Correspondence to Michael H. Soike.

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The authors declare that they have no competing interests.

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Soike, M.H., McTyre, E.R., Hughes, R.T. et al. Initial brain metastasis velocity: does the rate at which cancers first seed the brain affect outcomes?. J Neurooncol 139, 461–467 (2018). https://doi.org/10.1007/s11060-018-2888-3

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  • DOI: https://doi.org/10.1007/s11060-018-2888-3

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