Evaluation of Response to Stereotactic Radiosurgery and Survival Outcomes in Patients with Brain Metastases from Gastrointestinal Cancers

Öz

Aim: Gastrointestinal cancers rarely metastasize to the brain and constitute 4-8% of all brain metastases (BM). Survival is generally poor for BM from gastrointestinal cancers and stereotactic radiosurgery (SRS) is frequently used in its management. Since the data are still insufficient due to their rare presentation, we aim to analyze the clinical results of patients who underwent SRS for BM due to gastrointestinal cancers. Material and Method: We retrospectively reviewed patients with BM from gastrointestinal cancers who received robotic SRS with CyberKnife at our institute from October 2013 to December 2022. Clinical characteristics and treatment outcomes were recorded. Study endpoints were local control rates, distant brain control rates, and overall survival (OS). Results: A total of 61 BM were detected in 42 patients. The median clinical follow-up time was 7 (0.5-36) months. Nine lesions progressed in the irradiated area, 14 new lesions were observed outside the irradiated area. The local control rate was 85.1% and the distant brain control rate was 77%. The median OS was 8 months; 12-month and 24-month OS were 31.6% and 10.5%, respectively. Patients with high performance status had better OS (p=0.016). The prognostic scoring scales RPA and GI-GPA were both associated with OS (p=0.049, p=0.002). Multivariate analysis found a significant association between GI-GPA classes and OS (p=0.011). Conclusion: We obtained comparable results in terms of local control, distant brain control and OS in this challenging patient population. The use of GI-GPA prognostic scoring scales in routine practice will guide the selection of the most appropriate patient for SRS.

Anahtar Kelimeler

• Brain metastases
• Gastrointestinal Cancer
• Prognosis
• Stereotactic Radiosurgery

Gastrointestinal Kanserlerden Gelişen Beyin Metastazı Olan Hastalarda Stereotaktik Radyocerrahiye Yanıtın ve Sağkalım Sonuçlarının Değerlendirilmesi

Öz

Amaç: Gastrointestinal kanserler nadiren beyne metastaz yapar ve tüm beyin metastazlarının (BM) %4-8'ini oluşturur. Gastrointestinal kanserlerden gelişen BM için prognoz genellikle kötüdür ve tedavisinde stereotaktik radyocerrahi (SRS) sıklıkla kullanılır. Nadir prezentasyonları nedeniyle veriler hala yetersiz olduğundan, gastrointestinal kanserlerden gelişen BM için SRS uygulanan hastaların klinik sonuçlarını analiz etmeyi amaçladık. Gereç ve Yöntem: Ekim 2013'ten Aralık 2022'ye kadar enstitümüzde CyberKnife ile robotik SRS alan gastrointestinal kanserlerden gelişen BM'li hastaları retrospektif olarak incelendi. Klinik özellikler ve tedavi sonuçları kaydedildi. Çalışma sonlanım noktaları, yerel kontrol oranları, uzak beyin kontrol oranları ve genel sağkalım (OS) idi. Bulgular: 42 hastada toplam 61 BM tespit edildi. Ortalama klinik takip süresi 7 (0,5-36) aydı. Işınlanan sahada 9 lezyonda progresyon izlenirken, ışınlanan alan dışında 14 yeni lezyon gözlendi. Lokal kontrol oranı %85,1, uzak beyin kontrol oranı ise %77 olarak saptandı. Medyan OS 8 aydı; 12 aylık ve 24 aylık OS sırasıyla %31,6 ve %10,5 idi. Performans durumu yüksek olan hastaların OS'si daha iyiydi (p=0,016). Prognostik skorlama ölçeklerinden RPA ve GI-GPA'nın her ikisi de OS ile ilişkiliydi (p=0,049, p=0,002). Çok değişkenli analizde, GI-GPA sınıfları ile OS arasında anlamlı bir ilişki bulundu (p=0,011). Sonuç: Bu zorlu hasta popülasyonunda lokal kontrol, uzak beyin kontrolü ve OS açısından karşılaştırılabilir sonuçlar elde ettik. GI-GPA prognostik skorlama ölçeklerinin rutin uygulamada kullanılması, SRS için en uygun hastanın seçimine yol gösterecektir.

Anahtar Kelimeler

• Beyin Metastazı
• Gastrointestinal Kanser
• Prognoz
• Stereotaktik Radyocerrahi

Kaynakça

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