Journal Information
Vol. 28. Issue 2.
Pages 75-87 (March - April 2017)
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Vol. 28. Issue 2.
Pages 75-87 (March - April 2017)
Clinical research
Experience with the radiosurgical treatment of brain metastases
Experiencia en el manejo de metástasis cerebrales tratadas con radiocirugía estereotáctica
Pablo Fernández-de Aspea, Alejandro Fernández-Quintoa, Andrea Guerro-Moyaa, Eduardo Arán-Echabea,b, Ana Varela-Pazosc, Paula Peleteiro-Higueroc, Luis Cascalla-Canedac, Miguel Gelabert-Gonzáleza,b,
Corresponding author
miguel.gelabert@usc.es

Corresponding author.
a Departamento de Cirugía, Universidad de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
b Servicio de Neurocirugía, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
c Servicio de Oncología Radioterápica, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
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Tables (7)
Table 1. General characteristics.
Table 2. Data on metastases and whole-brain radiotherapy.
Table 3. Distribution according to clinical scales.
Table 4. Differences in variables between living and deceased subjects.
Table 5. Models of univariate Cox regression.
Table 6. Model 1 of multivariate Cox regression.
Table 7. Model 2 of multivariate Cox regression.
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Abstract
Objective

To analyse the survival rate of a cohort of patients with intracranial metastases treated with radiosurgery, and to determine the factors that influence the results.

Patients and method

Retrospective analysis performed on a cohort of 126 patients undergoing radiosurgery for brain metastases. Patients treated with surgery before or after radiosurgery were excluded. Survival is analysed based on clinical (age, sex, primary tumour), radiological (number, location and volume of lesions), and radiotherapy factors (treatment dose, holocraneal radiation). Univariate and multivariate analyses were performed to determine significant prognostic factors.

Results

A total of 225 brain metastases in 126 patients, with a mean age of 59.8±11.6years, were treated between February 2008 and April 2015. The mean survival was 8.2 months. The overall survival rates at 6months, 1year, and 2years were 60.3%, 31.5%, and 12.8%, respectively. Lung (59.5%) and breast (14.3) were the most common primary tumours, and the most common site for metastases was the cerebral hemisphere (77%) and the average volume was 10.35cc (0.2–43.5). Significant survival factors were: age under 60 (p=0.046), female (p<0.001), breast cancer (p<0.001), KPS >80 (p=0.001), SIR6 >5 (p=0.031), and GPA ≥2.5 (p=0.003).

Conclusions

Radiosurgery is an appropriate technique for the treatment of brain metastases, and the main prognostic factors include being age under 65, female, breast cancer, and good scores on Karnofsky, SIR, and GPA scales.

Keywords:
Brain metastases
Linear accelerator
Oncology
Radiosurgery
Radiotherapy
Whole-brain radiation therapy
Resumen
Objetivos

Analizar la supervivencia de una cohorte de pacientes con metástasis cerebrales tratados con radiocirugía y determinar qué factores pueden influir en los resultados.

Pacientes y método

Estudio retrospectivo descriptivo sobre una cohorte de 126 pacientes diagnosticados de metástasis intracraneal tratados con radiocirugía. Se excluyeron aquellos casos en los que se realizó cirugía (antes o después de la radiocirugía). Se analizó la supervivencia en función de factores clínicos (edad, sexo, tumor primario), radiológicos (número, localización y volumen de las lesiones) y de radioterapia (dosis de tratamiento, radioterapia holocraneal). Se realizó análisis univariante y multivariante de regresión de Cox.

Resultados

Entre febrero de 2008 y abril de 2015 se trataron 225 metástasis cerebrales en 126 pacientes con edad media de 59,8±11,6años. La mediana de supervivencia fue de 8,2meses. La supervivencia global a los 6, 12 y 24meses fue del 60,3, del 31,5 y del 12,8%, respectivamente. Los orígenes más frecuentes fueron pulmonar (59,5%) y mama (14,3%), y la localización principal, los hemisferios cerebrales (77%). El volumen medio fue de 10,35cc (0,2-43,5). Se encontraron como factores significativos de supervivencia, entre otros: edad menor de 60años (p=0,046), sexo femenino (p<0,001), cáncer de mama (p<0,001); KPS >80 (p=0,001), puntuación en la escala SIR >6,5 (p=0,031), escala GPA ≥2,5 (p=0,003).

Conclusiones

La radiocirugía es una técnica adecuada para el tratamiento de las metástasis cerebrales, y entre los factores pronósticos encontrados destacan la edad menor de 60años, el sexo femenino y las mejores puntuaciones en las escalas de Karfnosky, SIR y GPA.

Palabras clave:
Acelerador lineal
Metástasis cerebral
Oncología
Radiocirugía
Radioterapia
Radioterapia holocraneal

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