Stereotactic Radiosurgery Results for Patients With Brain Metastases From Gastrointestinal Cancer: A Retrospective Cohort Study of 802 Patients With GI-GPA Validity Test

The safety and efficacy of stereotactic radiosurgery in patients with gastrointestinal cancer brain metastasis: a systematic review and meta-analysis

Central nervous system Tumors, including metastasis, are a considerable source of morbidity and mortality. Currently, treatment options such as surgery, radiotherapy, and chemotherapy have been introduced to prevent the progression of the disease, but still, these patients do not have a good prognosis. Stereotactic radiosurgery (SRS) reduces the damage to the surroundings by focusing the radiation on the tumor tissue. In this paper, we aim to investigate the outcomes of SRS on patients with gastrointestinal-originated brain metastases. A systematic review and meta-analysis used the PRISMA guideline from inception until 27th March 2024, utilizing the relevant key terms. Records were screened and included based on pre-defined inclusion and exclusion criteria. Demanding data was extracted and analyzed using STATA v. 17. This meta-analysis of 29 studies examining SRS for brain metastases from gastrointestinal cancers revealed several significant findings. The pooled distant intracranial disease rate was 33% (95% CI: 0.21-0.45). Local tumor control rates were high, with an overall pooled rate of 88% (95% CI: 0.83-0.92). Survival outcomes showed a 6-month overall survival (OS) rate of 47% (95% CI: 0.42-0.52), decreasing to 32% at one year and 11% at two years. The 5-year OS rate was 2% (95% CI: 0.01-0.03). Subgroup analyses revealed variations in outcomes based on primary tumor site, with gastric cancer patients showing better short-term survival (73% at six months) compared to hepatic primaries (31% at six months). The 6-month progression-free survival (PFS) rate was 67% (95% CI: 0.12-1.22). Tumor control outcomes showed complete regression in 11% of cases, partial regression in 44%, stable disease in 30%, and progression in 20%. The overall mortality rate was 84% (95% CI: 0.75-0.93). This meta-analysis supports the efficacy of SRS in managing brain metastases from gastrointestinal cancers. SRS offers effective local control and may improve quality of life despite poor long-term outcomes. The high rates of distant intracranial progression underscore the need for comprehensive management strategies addressing both local and systemic disease. Future research should optimize patient selection, combine SRS with novel systemic therapies, and identify predictive biomarkers to improve outcomes in this challenging patient population.

Concomitant radiosurgical and targeted oncological treatment improves the outcome of patients with brain metastases from gastrointestinal cancer

BACKGROUND

So far, only limited studies exist that evaluate patients with brain metastases (BM) from GI cancer and associated primary cancers who were treated by Gamma Knife Radiosurgery (GKRS) and concomitant immunotherapy (IT) or targeted therapy (TT).

METHODS

Survival after GKRS was compared to the general and specific Graded Prognostic Assessment (GPA) and Score Index for Radiosurgery (SIR). Further, the influence of age, sex, Karnofsky Performance Status Scale (KPS), extracranial metastases (ECM) status at BM diagnosis, number of BM, the Recursive Partitioning Analysis (RPA) classes, GKRS1 treatment mode and concomitant treatment with IT or TT on the survival after GKRS was analyzed. Moreover, complication rates after concomitant GKRS and mainly TT treatment are reported.

RESULTS

Multivariate Cox regression analysis revealed IT or TT at or after the first Gamma Knife Radiosurgery (GKRS1) treatment as the only significant predictor for overall survival after GKRS1, even after adjusting for sex, KPS group, age group, number of BM at GKRS1, RPA class, ECM status at BM diagnosis and GKRS treatment mode. Concomitant treatment with IT or TT did not increase the rate of adverse radiation effects. There was no significant difference in local BM progression after GKRS between patients who received IT or TT and patients without IT or TT.

CONCLUSION

Good local tumor control rates and low rates of side effects demonstrate the safety and efficacy of GKRS in patients with BM from GI cancers. The concomitant radiosurgical and targeted oncological treatment significantly improves the survival after GKRS without increasing the rate of adverse radiation effects. To provide local tumor control, radiosurgery remains of utmost importance in modern GI BM management.

Local Control and Survival Outcomes After Stereotactic Radiosurgery for Brain Metastases From Gastrointestinal Primaries: An International Multicenter Analysis

BACKGROUND

There are limited data regarding outcomes for patients with gastrointestinal (GI) primaries and brain metastases treated with stereotactic radiosurgery (SRS).

OBJECTIVE

To examine clinical outcomes after SRS for patients with brain metastases from GI primaries and evaluate potential prognostic factors.

METHODS

The International Radiosurgery Research Foundation centers were queried for patients with brain metastases from GI primaries managed with SRS. Primary outcomes were local control (LC) and overall survival (OS). Kaplan-Meier analysis was used for univariate analysis (UVA) of prognostic factors. Factors significant on UVA were evaluated with a Cox multivariate analysis proportional hazards model. Logistic regressions were used to examine correlations with RN.

RESULTS

We identified 263 eligible patients with 543 brain metastases. Common primary sites were rectal (31.2%), colon (31.2%), and esophagus (25.5%) with a median age of 61.6 years (range: 37-91.4 years) and a median Karnofsky performance status (KPS) of 90% (range: 40%-100%). One-year and 2-year LC rates were 83.5% (95% CI: 78.9%-87.1%) and 73.0% (95% CI: 66.4%-78.5%), respectively. On UVA, age >65 years ( P = .001), dose <20 Gy ( P = .006) for single-fraction plans, KPS <90% ( P < .001), and planning target volume ≥2cc ( P = .007) were associated with inferior LC. All factors other than dose were significant on multivariate analysis ( P ≤ .002). One-year and 2-year OS rates were 68.0% (95% CI: 61.5%-73.6%) and 31.2% (95% CI: 24.6%-37.9%), respectively. Age > 65 years ( P = .006), KPS <90% ( P = .005), and extracranial metastases ( P = .05) were associated with inferior OS.

CONCLUSION

SRS resulted in comparable LC with common primaries. Age and KPS were associated with both LC and OS with planning target volume and extracranial metastases correlating with LC and OS, respectively. These factors should be considered in GI cancer patient selection for SRS.