KEY TAKEAWAYS
- The study aimed to assess the comparative efficacy of management paradigms of LMB viz. FSRS, SSRS, postop-FSRS, and preop-SRS.
- The primary endpoints of the study were LF, RN, LMD and DIF.
- This benchmark study compared 4 SRS methods for LBM, revealing no significant differences in outcomes between non-operative and operative approaches.
This study compares four management paradigms for large brain metastasis (LMB) a type of secondary brain cancer fractionated SRS (FSRS), staged SRS (SSRS), resection and postoperative-FSRS (postop-FSRS), and preoperative-SRS (preop-SRS).
Tugce Kutuk and the team aimed to evaluate the relative outcomes of these approaches in terms of local control, overall survival (OS), and adverse effects.
Researchers registered patients (pts) with LBM (≥ 2 cm) from July 2017 to January 2022 to the study. The primary endpoints of the analysis were local failure (LF), radiation necrosis (RN), leptomeningeal disease (LMD), a composite of these variables, and distant intracranial failure (DIF).
To analyze the data, Gray’s test was employed to compare cumulative incidence rates while accounting for death as a competing risk. Additionally, a random survival forests (RSF) machine-learning model was utilized to further evaluate the outcomes.
Results showed that 183 pts were treated for 234 LBMs, with management strategies distributed as follows: 31.6% received postop-FSRS, 28.2% underwent SSRS, 20.1% were treated with FSRS, and 20.1% had preop-SRS.
The overall 1-year composite endpoint rates were similar between nonoperative and operative approaches (21% vs. 20%). However, the 1-year RN rate was higher in nonoperative strategies (8%) compared to operative strategies (4%, P= 0.012), and the 1-year OS was lower in nonoperative strategies (48%) compared to operative strategies (69%, P= 0.001). Additionally, the 1-year LMD rate was slightly higher in nonoperative strategies (10%) compared to operative strategies (5%, P= 0.052).
Further analysis using the RSF model revealed an out-of-bag error rate of 47% for the composite endpoint. The key identified risk factors included widespread extracranial disease, more than 5 total lesions, and breast cancer histology.
The study was a benchmark research that presented a head-to-head retrospective comparison of 4 SRS methods. Also addressed the lack of randomized data in the LBM niche amongst treatment frameworks. Irrespective of patient characteristic trends, no significant differences were found in LF, composite endpoint, and DIF rates between non-operative and operative approaches.
No funding information was given.
Source: https://pubmed.ncbi.nlm.nih.gov/38837019/
Kutuk T, Zhang Y, Akdemir EY, et al. (2024). “Comparative evaluation of outcomes amongst different radiosurgery management paradigms for patients with large brain metastasis.” J Neurooncol. 2024 Aug;169(1):105-117. doi: 10.1007/s11060-024-04706-2. Epub 2024 Jun 5. PMID: 38837019.
