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.

Ain Shams University Cairo Egypt

Department of Clinical Oncology Ain Shams University Cairo Egypt

Department of Neurological Surgery University of Pittsburgh School of Medicine Pittsburgh Pennsylvania USA

Department of Neurological Surgery University of Virginia Charlottesville Virginia USA

Department of Neurosurgery Ain Shams University Cairo Egypt

Department of Neurosurgery Allegheny Health Network Pittsburgh Pennsylvania USA

Department of Neurosurgery Benha University Banha Egypt

Department of Neurosurgery Gamma Knife Center Jewish Hospital Mayfield Clinic Cincinnati Ohio USA

Department of Neurosurgery Gamma Knife Center Nasser Institute Hospital Cairo Egypt

Department of Neurosurgery Humanitas Research Hospital IRCCS Rozzano Italy

Department of Neurosurgery Koc University School of Medicine Istanbul Turkey

Department of Neurosurgery National Yang Ming Chiao Tung University School of Medicine Taipei China

Department of Neurosurgery Neurological Institute Taipei Veteran General Hospital Taipei China

Department of Neurosurgery Rose Ella Burkhart Brain Tumor and Neuro Oncology Center Neurological Institute Cleveland Clinic Cleveland Ohio USA

Department of Neurosurgery Université de Sherbrooke Sherbrooke Canada

Department of Neurosurgery University of Alberta Edmonton Canada

Department of Neurosurgery University of Pennsylvania Philadelphia Pennsylvania USA

Department of Neurosurgery Yale University School of Medicine New Haven Connecticut USA

Department of Radiation Oncology Allegheny Health Network Pittsburgh Pennsylvania USA

Department of Radiation Oncology Mayo Clinic Florida Jacksonville Florida USA

Department of Radiation Oncology National Cancer Institute Cairo University Giza City Egypt

Department of Radiation Oncology University of Virginia Charlottesville Virginia USA

Department of Radiation Oncology Virginia Commonwealth University Health System Richmond Virginia USA

Department of Stereotactic and Radiation Neurosurgery Na Homolce Hospital Prague Czechia

Departments of Radiation Oncology and Neurosurgery The James Cancer Hospital and Solove Research Institute Ohio State University Wexner Medical Center Columbus Ohio USA

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