Ela DELİKGÖZ SOYKUT, Eylem ODABASİ, Serdar ŞENOL, Salih Buğra YILMAZ, Hatice TATAROĞLU, Ahmet BARAN

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

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

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

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.

Keywords:

Brain metastases, Gastrointestinal Cancer, Prognosis, Stereotactic Radiosurgery,

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1. Patchell RA. The management of brain metastases. Cancer Treat Rev. 2003;29(6):533-40. doi:10.1016/s0305-7372(03)00105-1
2. Trifiletti DM, Patel N, Lee CC, Romano AM, Sheehan JP. Stereotactic radiosurgery in the treatment of brain metastases from gastrointestinal primaries. J Neurooncol. 2015;124(3):439-46. doi:10.1007/s11060-015-1857-3
3. Ghidini M, Petrelli F, Hahne JC, et al. Clinical outcome and molecular characterization of brain metastases from esophageal and gastric cancer: a systematic review. Med Oncol. 2017;34(4):62. doi:10.1007/s12032-017-0919-0
4. Lin L, Zhao CH, Ge FJ, et al. Patients with brain metastases derived from gastrointestinal cancer: clinical characteristics and prognostic factors. Clin Transl Oncol. 2016;18(1):93-8. doi:10.1007/s12094-015-1341-8
5. Mjahed RB, Astaras C, Roth A, Koessler T. Where Are We Now and Where Might We Be Headed in Understanding and Managing Brain Metastases in Colorectal Cancer Patients?. Curr Treat Options Oncol. 2022;23(7):980-1000. doi:10.1007/s11864-022-00982-0
6. Aoyama H, Shirato H, Tago M, et al. Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA. 2006;295(21):2483-91. doi:10.1001/jama.295.21.2483
7. Chang EL, Wefel JS, Hess KR, et al. Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol. 2009;10(11):1037-44. doi:10.1016/S1470-2045(09)70263-3
8. Page BR, Wang EC, White L, et al. Gamma Knife radiosurgery for brain metastases from gastrointestinal primary. J Med Imaging Radiat Oncol. 2017;61(4):522-7. doi:10.1111/1754-9485.12584
9. World Medical Association. World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. Bull World Health Organ. 2001;79(4):373-4.
10. Agboola O, Benoit B, Cross P, et al. Prognostic factors derived from recursive partition analysis (RPA) of Radiation Therapy Oncology Group (RTOG) brain metastases trials applied to surgically resected and irradiated brain metastatic cases. Int J Radiat Oncol Biol Phys. 1998;42(1):155-9. doi:10.1016/s0360-3016(98)00198-9
11. Sperduto PW, Kased N, Roberge D, et al. Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases. J Clin Oncol. 2012;30(4):419-25. doi:10.1200/JCO.2011.38.0527
12. Eisenhauer EA, Therasse P, Bogaerts J, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009;45(2):228-47. doi:10.1016/j.ejca.2008.10.026
13. Da Silva AN, Nagayama K, Schlesinger DJ, Sheehan JP. Gamma Knife surgery for brain metastases from gastrointestinal cancer. J Neurosurg. 2009;111(3):423-30. doi:10.3171/2008.9.JNS08281
14. Paudel N, Helenowski I, Kane L, et al. Stereotactic radiosurgery for the treatment of brain metastasis from gastrointestinal primary cancers. J Radiosurg SBRT. 2019;6(1):27-34.
15. Sanghvi SM, Lischalk JW, Cai L, et al. Clinical outcomes of gastrointestinal brain metastases treated with radiotherapy. Radiat Oncol. 2017;12(1):43. doi:10.1186/s13014-017-0774-3
16. Navarria P, Minniti G, Clerici E, et al. Brain metastases from primary colorectal cancer: is radiosurgery an effective treatment approach? Results of a multicenter study of the radiation and clinical oncology Italian association (AIRO). Br J Radiol. 2020;93(1116):20200951. doi:10.1259/bjr.20200951
17. Singh R, Bowden G, Mathieu D, et al. Local Control and Survival Outcomes After Stereotactic Radiosurgery for Brain Metastases From Gastrointestinal Primaries: An International Multicenter Analysis. Neurosurgery. 2023;93(3):592-8. doi:10.1227/neu.0000000000002456
18. Sahgal A, Aoyama H, Kocher M, et al. Phase 3 trials of stereotactic radiosurgery with or without whole-brain radiation therapy for 1 to 4 brain metastases: individual patient data meta-analysis. Int J Radiat Oncol Biol Phys. 2015;91(4):710-7. doi:10.1016/j.ijrobp.2014.10.024
19. Yamamoto M, Serizawa T, Sato Y, et al. Stereotactic Radiosurgery Results for Patients With Brain Metastases From Gastrointestinal Cancer: A Retrospective Cohort Study of 802 Patients With GI-GPA Validity Test. Adv Radiat Oncol. 2021;6(6):100721. doi:10.1016/j.adro.2021.100721
20. Hasegawa T, Kondziolka D, Flickinger JC, Lunsford LD. Stereotactic radiosurgery for brain metastases from gastrointestinal tract cancer. Surg Neurol. 2003;60(6):506-15. doi:10.1016/s0090-3019(03)00356-2
21. Han JH, Kim DG, Chung HT, Kim CY, Park CK, Chung YS, Paek SH, Yoo MW, Kim BH, Jung HW. Radiosurgery for brain metastasis from advanced gastric cancer. Acta Neurochir (Wien). 2010 Apr;152(4):605-10. doi: 10.1007/s00701-009-0554-4.
22. Park YS, Chang JH, Chang JW, Park YG. The efficacy of gamma knife radiosurgery for advanced gastric cancer with brain metastases. J Neurooncol. 2011;103(3):513-21. doi:10.1007/s11060-010-0405-4
23. Zheng C, Weng Y, Xu Q. Stereotactic radiosurgery for the treatment of esophageal carcinoma brain metastases. J BUON. 2021;26(5):2126-30.
24. Gu XD, Cai YT, Zhou YM, Li ZY, Xiang JB, Chen ZY. Prognostic factors and multidisciplinary treatment modalities for brain metastases from colorectal cancer: analysis of 93 patients. BMC Cancer. 2015;15:902. doi:10.1186/s12885-015-1933-2
25. Li Y, Wu J, Liu F, et al. Single-fraction SRS and multiple-fraction SRT for brain metastases from colorectal cancer. Front Oncol. 2022;12:1060570. doi:10.3389/fonc.2022.1060570