Treatment of brain metastases from gastrointestinal primaries: Comparing whole-brain radiotherapy and stereotactic radiosurgery in terms of survival

OBJECTIVE: The objective of the study was to analyze the clinical features and prognostic factors for survival in patients with brain metastasis (BM) from gastrointestinal primaries treated with whole-brain radiotherapy (WBRT) or stereotactic radiosurgery (SRS).
METHODS: We retrospectively investigated patients with BMs resulting from gastrointestinal primaries who underwent WBRT or SRS. The effects of treatment modalities on overall survival (OS) were calculated by the Kaplan–Meier method.
RESULTS: WBRT and SRS were applied to 24 and 17 patients, respectively. In the WBRT group, radiotherapy was delivered at 20–30 Gy in 5–10 fractions (fx). In the SRS group, a median dose of 22 Gy (range: 18–27 Gy) was applied in 1–3 fx. At BM diagnosis, all patients had synchronous extracranial metastases which were mostly detected in the lung and liver. Median OS values were 9 months and 4 months in the SRS and WBRT groups, respectively (p=0.005). Karnofsky performance status (KPS) score (≥70 vs. <70), diagnosis-specific graded prognostic index, gastrointestinal (GI) graded prognostic index, cumulative intracranial tumor volume (CITV), controlled systemic disease, and treatment modality (WBRT vs. SBRT) were found to be related with OS.
CONCLUSION: In patients with GI cancer-related BMs, SRS should be preferred in those with longer OS expectancy who have controlled extracranial disease, good KPS and CITV values of <10 cm3.

Gastrointestinal Primerlerden Beyin Metastazlarýnýn Tedavisi: Tüm Beyin Radyoterapisi ile Stereotaktik Radyocerrahinin Saðkalým Açýsýndan Karþýlaþtýrýlmasý

AMAÇ: Bu çalýþmada tüm beyin radyoterapisi (WBRT) veya stereotaktik radyocerrahi (SRS) ile tedavi edilen, gastrointestinal sistem tümörlerinden kaynaklanan beyin metastazý (BM) bulunan hastalarda saðkalým açýsýndan klinik özellikleri ve prognostik faktörleri analiz etmeyi amaçladýk.
METOD: WBRT veya SRS uygulanan gastrointestinal primerlerden kaynaklanan beyin metastazlarý (BM'ler) olan hastalarý retrospektif olarak araþtýrdýk. Tedavi modalitelerinin genel saðkalým (OS) üzerindeki etkileri Kaplan-Meier yöntemi ile hesaplandý.
BULGULAR: Yirmi dört hastaya WBRT ve 17 hastaya SRS uygulandý. WBRT grubunda total doz 20-30 Gy olacak þekilde 5-10 fraksiyonda (fx) radyoterapi uygulandý. SRS grubunda 1-3 fraksiyonda ortanca doz 22 Gy (aralýk: 18-27 Gy) radyoterapi uygulandý. BM taný anýnda, tüm hastalarda en sýk akciðer ve karaciðerde olmak üzere senkron ekstrakraniyal metastazlar mevcuttu. Medyan OS; SRS ve WBRT gruplarýnda sýrasýyla 9 ay ve 4 ay idi (p = 0,005). KPS (Karnofsky performans skoru) (≥70 vs <70), ds-GPA (prognostik deðerlendirme derecesi), GI-GPA(gastrointestinal prognostik deðerlendirme derecesi), kümülatif intrakraniyal tümör hacmi (CITV), kontrollü sistemik hastalýk ve tedavi modalitesi (WBRT vs SBRT) OS ile iliþkili bulundu.
SONUÇ: Ekstrakraniyal hastalýðý kontrol altýnda, KPS iyi ve CITV deðerleri <10 cm3 olup genel saðkalým beklentisi daha uzun olan gastrointestinal kanserlerden kaynaklanan beyin metastazlý hastalarda stereotaktik radyocerrahi tercih edilmelidir. (NCI-2021-9-2/R1)