Session Item

In the last years there have been important advances in the management of metastatic cancer. Radiosurgery (SRS) has also evolved, and its indications have been better defined. In this study we analyse the evolution of overall survival (OS) of patients with brain metastases (BM) treated with SRS over a period of 10 years in a single institution. We have also analysed how surgery and WBRT influenced in OS, local control (LC) and brain control (BC). 

We have analysed retrospectively our results from January 2010 to December 2019 divided into 3 equal periods: Period A (January 2010-April 2013), Period B (May 2013-August 2016) and Period C (September 2016-Decembre 2019).

We studied patients’ characteristics, SRS parameters and other treatments (surgery and/or WBRT). We analysed LC, BC and OS.

The statistical analyses were based on Kaplan Meier, Log-Rank and Cox Regression tests, run on SPSS.

204 patients. Median age of 60y were treated. A single BM in 74,6%. BM origin were lung (60%), breast (13,2%), colorectal (6,8%) and others (20%),

SRS schemes were 20Gy/1fx (40,5%), 18Gy/1fx (19,5%), 25Gy/5fx (10,3%) and others (19,7%). From 2010 to 2018 patients were treated in a Varian Trilogy accelerator with rigid frames or an optically-guided frameless system. From 2019 patients were treated in Varian Truebeam accelerator with Brainlab frameless mask and ExacTrac X-ray image guidance. 

Median follow-up was 10 months (17 months for living patients).

Patients treated during Periods A, B and C were 49 (24%), 56 (27,5%) and 99 (48,5%) respectively.

Previous surgery: 19%. Period A: 15%. Period B: 15%. Period C: 25%.

Previous WBRT: 36%. Period A: 85%. Period B: 33%. Period C: 14%.

Median OS: 13m. 1y-OS: 51,4%. Period A: 6m. Period B: 16m. Period C: 18m (p 0,02). OS with and without surgery was 20m and 12m respectively (p=0,02). OS with and without WBRT was 10m and 15m respectively (p=0,35).

Median LC: 47m. 1y-LC: 77.8%. Period A: 77,3%. Period B: 71,5%. Period C: 81,6% (p=0,365). LC with and without surgery was not reached and 47m respectively (p=0,19). LC with and without WBRT was 75,8 m and 78,4 m respectively (p>0,05).

Median BC: 67m. 1y-BC: 69,2%. Period A: 76,8%. Period B: 73,4%. Period C: 61,7% (p=0,07). BC with and without surgery was 22m and not reached respectively (p=0,19). BC with and without WBRT was not reached and 30m respectively (p=0,01).

We observe a good implantation of SRS along this period and patients OS has increased. This may be related to a better selection of cases for upfront SRS or previous surgery, improvement of systemic therapies, improvement of SRS techniques and a better detection and treatment of complications.

Over the years, the number of operated cases has increased. After surgery OS improves, but we observe a tendence to a worse BC. RTHC improves BC but does not influence OS. Over the years its use has decreased.

In general, the results are consistent with what has been published in large series on the subject.