ArticleNeuro-oncology advances
Linac-based stereotactic radiosurgery for brain metastases: Survival and salvage treatment in a contemporary cohort of 3893 patients.
Article in Neuro-oncology advances. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Real-world outcomes after stereotactic radiosurgery (SRS) for brain metastases across the full burden spectrum are limited. We tested whether overall survival (OS) in higher-burden lesion groups is non-inferior to a 5-10 lesion reference and characterized salvage patterns, including whole-brain radiotherapy (WBRT). Methods: A total of 3893 consecutive patients received linac-based SRS (1-5 fractions) at seven sites of an NCI-designated cancer center network (2017-2026), stratified by lesion count (1, 2-4, 5-10, 11-20, >20). Multivariable Cox regression used 5-10 as reference; pre-specified non-inferiority testing (margin HR 1.30, one-sided α = 0.025) compared higher-burden groups. Cumulative incidences of salvage interventions used death as the competing event. Results: Median age 65 years; median follow-up 41.2 months. 77% had 1-4, 17% had 5-10, and 6% had >10 lesions (maximum 140). Median OS was 16.2, 11.0, 8.2, 8.7, and 6.5 months for the 1, 2-4, 5-10, 11-20, and >20 groups. OS was significantly better for 1 (HR 0.62, 0.55-0.69) and 2-4 (HR 0.81, 0.73-0.90) versus 5-10; non-inferiority was met for 11-20 ( Conclusions: OS plateaued from 5 through 20 lesions, with non-inferiority to the 5-10 reference established for 11-20; the >20 group (
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