Skip to main content

Advertisement

SpringerLink
Log in

Impact of brain metastasis velocity on neurologic death for brain metastasis patients experiencing distant brain failure after initial stereotactic radiosurgery

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

Abstract

Purpose

Patients with high rates of developing new brain metastases have an increased likelihood of dying of neurologic death. It is unclear, however, whether this risk is affected by treatment choice following failure of primary stereotactic radiosurgery (SRS).

Methods

From July 2000 to March 2017, 440 patients with brain metastasis were treated with SRS and progressed to have a distant brain failure (DBF). Eighty-seven patients were treated within the immunotherapy era. Brain metastasis velocity (BMV) was calculated for each patient. In general, the institutional philosophy for use of salvage SRS vs whole brain radiotherapy (WBRT) was to postpone the use of WBRT for as long as possible and to treat with salvage SRS when feasible. No further treatment was reserved for patients with poor life expectancy and who were not expected to benefit from salvage treatment.

Results

Two hundred and eighty-five patients were treated with repeat SRS, 91 patients were treated with salvage WBRT, and 64 patients received no salvage radiation therapy. One-year cumulative incidence of neurologic death after salvage SRS vs WBRT was 15% vs 23% for the low- (p = 0.06), 30% vs 37% for the intermediate- (p < 0.01), and 31% vs 48% (p < 0.01) for the high-BMV group. Salvage WBRT was associated with increased incidence of neurologic death on multivariate analysis (HR 1.64, 95% CI 1.13–2.39, p = 0.01) when compared to repeat SRS. One-year cumulative incidence of neurologic death for patients treated within the immunotherapy era was 9%, 38%, and 38% for low-, intermediate-, and high-BMV groups, respectively (p = 0.01).

Conclusion

Intermediate and high risk BMV groups are predictive of neurologic death. The association between BMV and neurologic death remains strong for patients treated within the immunotherapy era.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Ellis TL, Neal MT, Chan MD (2012) The role of surgery, radiosurgery and whole brain radiation therapy in the management of patients with metastatic brain tumors. Int J Surg Oncol 2012:952345

    Google Scholar 

  2. Devoid H-M, McTyre ER, Page BR et al (2016) Recent advances in radiosurgical management of brain metastases. Front Biosci 8:203–214

    Article  Google Scholar 

  3. Lanier CM, Hughes R, Ahmed T et al (2019) Immunotherapy is associated with improved survival and decreased neurologic death after SRS for brain metastases from lung and melanoma primaries. Neurooncol Pract. https://doi.org/10.1093/nop/npz004

    Article  PubMed  Google Scholar 

  4. Kocher M, Soffietti R, Abacioglu U et al (2011) Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952–26001 study. J Clin Oncol 29:134–141

    Article  Google Scholar 

  5. Neal MT, Chan MD, Lucas JT Jr et al (2014) Predictors of survival, neurologic death, local failure, and distant failure after gamma knife radiosurgery for melanoma brain metastases. World Neurosurg 82:1250–1255

    Article  Google Scholar 

  6. Jensen CA, Chan MD, McCoy TP et al (2011) Cavity-directed radiosurgery as adjuvant therapy after resection of a brain metastasis. J Neurosurg 114:1585–1591

    Article  Google Scholar 

  7. Ayala-Peacock DN, Peiffer AM, Lucas JT et al (2014) A nomogram for predicting distant brain failure in patients treated with gamma knife stereotactic radiosurgery without whole brain radiotherapy. Neuro Oncol 16:1283–1288

    Article  Google Scholar 

  8. Shenker RF, McTyre ER, Taksler GB et al (2019) Analysis of the drivers of cost of management when patients with brain metastases are treated with upfront radiosurgery. Clin Neurol Neurosurg 176:10–14

    Article  Google Scholar 

  9. Churilla TM, Ballman KV, Brown PD et al (2017) Stereotactic radiosurgery with or without whole-brain radiation therapy for limited brain metastases: a secondary analysis of the north central cancer treatment group N0574 (Alliance) randomized controlled trial. Int J Radiat Oncol Biol Phys 99:1173–1178

    Article  Google Scholar 

  10. Soffietti R, Kocher M, Abacioglu UM et al (2013) A European organisation for research and treatment of cancer phase III trial of adjuvant whole-brain radiotherapy versus observation in patients with one to three brain metastases from solid tumors after surgical resection or radiosurgery: quality-of-life results. J Clin Oncol 31:65–72

    Article  Google Scholar 

  11. McTyre E, Ayala-Peacock D, Contessa J et al (2018) Multi-institutional competing risks analysis of distant brain failure and salvage patterns after upfront radiosurgery without whole brain radiotherapy for brain metastasis. Ann Oncol 29:497–503

    Article  CAS  Google Scholar 

  12. Farris M, McTyre ER, Cramer CK et al (2017) Brain metastasis velocity: a novel prognostic metric predictive of overall survival and freedom from whole-brain radiation therapy after distant brain failure following upfront radiosurgery alone. Int J Radiat Oncol Biol Phys 98:131–141

    Article  Google Scholar 

  13. Sperduto PW, Kased N, Roberge D et al (2012) Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases. J Clin Oncol 30:419–425

    Article  Google Scholar 

  14. Shaw E, Scott C, Souhami L et al (2000) Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90-05. Int J Radiat Oncol Biol Phys 47:291–298

    Article  CAS  Google Scholar 

  15. Dohm AE, Hughes R, Wheless W et al (2018) Surgical resection and postoperative radiosurgery versus staged radiosurgery for large brain metastases. J Neurooncol. https://doi.org/10.1007/s11060-018-03008-8

    Article  PubMed  Google Scholar 

  16. McTyre ER, Johnson AG, Ruiz J et al (2017) Predictors of neurologic and nonneurologic death in patients with brain metastasis initially treated with upfront stereotactic radiosurgery without whole-brain radiation therapy. Neuro Oncol 19:558–566

    CAS  PubMed  Google Scholar 

  17. McTyre ER, Soike MH, Farris M et al (2019) Multi-institutional validation of brain metastasis velocity, a recently defined predictor of outcomes following stereotactic radiosurgery. Radiother Oncol. https://doi.org/10.1016/j.radonc.2019.08.011

    Article  PubMed  Google Scholar 

  18. Yamamoto M, Aiyama H, Koiso T et al (2019) Validity of a recently proposed prognostic grading index, brain metastasis velocity, for patients with brain metastasis undergoing multiple radiosurgical procedures. Int J Radiat Oncol Biol Phys 103:631–637

    Article  Google Scholar 

  19. Patchell RA, Tibbs PA, Walsh JW et al (1990) A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 322:494–500

    Article  CAS  Google Scholar 

  20. Brown PD, Gondi V (2018) Irrational fear of whole-brain radiotherapy: are we doing our patients a disservice? Cancer 124:3468–3473

    Article  Google Scholar 

  21. Tawbi HA, Forsyth PA, Algazi A et al (2018) Combined nivolumab and ipilimumab in melanoma metastatic to the brain. N Engl J Med 379:722–730

    Article  CAS  Google Scholar 

  22. Johnson AG, Ruiz J, Hughes R et al (2015) Impact of systemic targeted agents on the clinical outcomes of patients with brain metastases. Oncotarget 6:18945–18955

    PubMed  PubMed Central  Google Scholar 

Download references

Funding

This work was not supported by any funding sources.

Author information

Authors and Affiliations

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

    Michael C. LeCompte, Ryan T. Hughes, Michael Farris, Claire Lanier, Chase Glenn, Christina K. Cramer & Michael D. Chan

  2. Department of Radiation Oncology, University Radiologists, S.C., Southern Illinois School of Medicine, Springfield, IL, 62781, USA

    Adrianna Masters

  3. Hazelrig-Salter Radiation Oncology Center, University of Alabama at Birmingham, Birmingham, AL, 35233, USA

    Michael H. Soike

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

    Kounosuke Watabe & Jing Su

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

    Jing Su

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

    Jimmy Ruiz

  7. W.G. (Bill) Hefner Veteran Administration Medical Center, Cancer Center, Salisbury, NC, 28144, USA

    Jimmy Ruiz

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

    Christopher T. Whitlow

  9. Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, 12180, USA

    Ge Wang

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

    Adrian W. Laxton & Stephen B. Tatter

Authors
  1. Michael C. LeCompte
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ryan T. Hughes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael Farris
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Adrianna Masters
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael H. Soike
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Claire Lanier
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Chase Glenn
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Christina K. Cramer
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Kounosuke Watabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Jing Su
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Jimmy Ruiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Christopher T. Whitlow
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Ge Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Adrian W. Laxton
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Stephen B. Tatter
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Michael D. Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Conceptualization Michael C. LeCompte, Ryan T. Hughes, Michael D. Chan; Data Curation Michael C. LeCompte, Ryan T. Hughes, Claire M. Lanier, Chase Glenn; Formal Analysis Michael C. LeCompte, Ryan T. Hughes; Funding Acquisition NA; Investigation: Michael C. LeCompte, Ryan T. Hughes; Methodology Michael C. LeCompte, Ryan T. Hughes, Michael Farris, Adrianna Masters, Michael H. Soike; Christina K. Cramer, Ge Wang, Michael D. Chan; Project Administration Michael C. LeCompte; Resources Jimmy Ruiz, Christopher T. Whitlow, Adrian W. Laxton, Stephen B. Tatter; Software Ryan T. Hughes; Supervision Michael D. Chan; Validation Michael C. LeCompte, Ryan T. Hughes; Visualization Michael C. LeCompte, Ryan T. Hughes, Michael D. Chan; Writing—Original Draft Preparation Michael C. LeCompte, Ryan T. Hughes, Michael D. Chan; Writing—Review & Editing Michael C. LeCompte, Ryan T. Hughes, Adrianna Masters, Michael H. Soike, Claire M. Lanier, Christina K. Cramer, Kounosuke Watabe, Michael D. Chan.

Corresponding author

Correspondence to Michael C. LeCompte.

Ethics declarations

Conflict of interest

There are no conflict of interest.

Ethical approval

Data was collected retrospectively, in accordance with the IRB.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

LeCompte, M.C., Hughes, R.T., Farris, M. et al. Impact of brain metastasis velocity on neurologic death for brain metastasis patients experiencing distant brain failure after initial stereotactic radiosurgery. J Neurooncol 146, 285–292 (2020). https://doi.org/10.1007/s11060-019-03368-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11060-019-03368-9

Keywords

Search

Navigation