PURPOSE: Bladder cancer rarely metastasizes to the brain. This study was performed to evaluate stereotactic radiosurgery (SRS) for the management of bladder cancer brain metastases. METHODS: Cases of bladder cancer brain metastases treated with SRS were collected by members of the International Radiosurgery Research Foundation (IRRF) and outcome data was analyzed for patients with at least one clinical or imaging follow-up. RESULTS: 103 patients received SRS for 301 brain metastases. Median age at SRS was 68 and 73.8% of patients were male. Median KPS was 80%. Median time from primary to brain metastases diagnosis was 18 months. At the time of SRS, 50% of patients had other systemic metastases. The median number of metastases treated was 1, and median cumulative SRS volume was 1.16 cc. Most patients had single fraction SRS using a median margin dose of 18 Gy. At the time of analysis, 9.7% of patients were alive. Median survival after SRS was 7 months. Local control was achieved for 89.3% of metastases, 42% of patients developed new remote brain metastases, and 4.9% had leptomeningeal dissemination. Subsequent management included repeat SRS in 21.7%, surgical resection in 8.8% and WBRT in 7.6% of patients. At last follow-up, 32.1% of patients had improvement of their symptoms, whereas 38.5% remained stable. Adverse radiation effects occurred in 4.3% of treated metastases. On multivariate analyses, KPS ≥ 80% and non-urothelial histology predicted improved survival, while absence of corticosteroid intake predicted longer tumor control. CONCLUSION: Bladder cancer brain metastases can be safely managed with SRS.

Department of Neurological Surgery University of Pittsburgh Medical Center Pittsburgh PA USA

Department of Neurosurgery Koc University School of Medicine Istanbul Turkey

Department of Neurosurgery NYU Langone Medical Center New York NY USA

Department of Neurosurgery Taipei Veteran General Hospital Taipei Taiwan

Department of Neurosurgery University of Virginia Charlottesville VA USA

Department of Neurosurgery Yale University New Haven CT USA

Department of Radiation Oncology Mayo Clinic Florida Jacksonville FL USA

Department of Radiation Oncology University of Colorado Denver CO USA

Department of Radiation Oncology Yale University New Haven CT USA

Department of Stereotactic and Radiation Neurosurgery Na Homolce Hospital Prague Czech Republic

Division of Neurosurgery Centre de recherche du CHUS Université de Sherbrooke Sherbrooke Qc Canada

Service de neurochirurgie CHUS 12 e avenue Nord Sherbrooke Qc 3001 Canada

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Saginala K, Barsouk A, Aluru JS et al (2020) Epidemiology of bladder cancer. Méd Sci 8:15. https://doi.org/10.3390/medsci8010015 DOI

Jubber I, Ong S, Bukavina L et al (2023) Epidemiology of bladder cancer in 2023: A systematic review of risk factors. Eur Urol 84:176–190. https://doi.org/10.1016/j.eururo.2023.03.029 PubMed DOI

Brenneman RJ, Gay HA, Christodouleas JP et al (2020) Review: brain metastases in bladder cancer. Bl Cancer 6:237–248. https://doi.org/10.3233/blc-200304 DOI

MAHMOUD-AHMED AS, SUH JH, KUPELIAN PA et al (2002) Brain metastases from bladder carcinoma: presentation, treatment and survival. J Urol 167:2419–2422. https://doi.org/10.1097/00005392-200206000-00017 PubMed DOI

Diamantopoulos LN, Khaki AR, Sonpavde GP et al (2020) Central nervous system metastasis in patients with urothelial carcinoma: institutional experience and a comprehensive review of the literature. Clin Genitourin Cancer 18:e266–e276. https://doi.org/10.1016/j.clgc.2019.11.008 PubMed DOI

Dyrskjøt L, Hansel DE, Efstathiou JA et al (2023) Bladder cancer. Nat Rev Dis Prim 9:58. https://doi.org/10.1038/s41572-023-00468-9 PubMed DOI

Brown PD, Ballman KV, Cerhan JH et al (2017) Postoperative stereotactic radiosurgery compared with whole brain radiotherapy for resected metastatic brain disease (NCCTG N107C/CEC·3): a multicentre, randomised, controlled, phase 3 trial. Lancet Oncol 18:1049–1060. https://doi.org/10.1016/s1470-2045(17)30441-2 PubMed DOI PMC

Brown PD, Jaeckle K, Ballman KV et al (2016) Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: A randomized clinical trial. JAMA 316:401–409. https://doi.org/10.1001/jama.2016.9839 PubMed DOI PMC

Menendez JY, Bauer DF, Shannon CN et al (2012) Stereotactic radiosurgical treatment of brain metastasis of primary tumors that rarely metastasize to the central nervous system. J Neuro-Oncol 109:513–519. https://doi.org/10.1007/s11060-012-0916-2 DOI

Taylor JM, McTyre ER, Tatter SB et al (2018) Gamma knife stereotactic radiosurgery for the treatment of brain metastases from primary tumors of the urinary bladder. Stereotact Funct Neurosurg 96:108–112. https://doi.org/10.1159/000488151 PubMed DOI

Lin NU, Lee EQ, Aoyama H et al (2015) Response assessment criteria for brain metastases: proposal from the RANO group. Lancet Oncol 16:e270–e278. https://doi.org/10.1016/s1470-2045(15)70057-4 PubMed DOI

Compérat E, Amin MB, Cathomas R et al (2022) Current best practice for bladder cancer: a narrative review of diagnostics and treatments. Lancet 400:1712–1721. https://doi.org/10.1016/s0140-6736(22)01188-6 PubMed DOI

Tan WS, Tan M-Y, Alhalabi O et al (2023) Evolving systemic management of urothelial cancers. Curr Opin Oncol 35:186–199. https://doi.org/10.1097/cco.0000000000000942 PubMed DOI

Apolo AB, Ballman KV, Sonpavde G et al (2024) Adjuvant pembrolizumab versus observation in Muscle-Invasive urothelial carcinoma. N Engl J Med. https://doi.org/10.1056/nejmoa2401726 PubMed DOI PMC

RADES D, NGUYEN T, SCHILD SE (2020) The results of Whole-brain radiotherapy for elderly patients with brain metastases from urinary bladder cancer. Vivo 34:1317–1320. https://doi.org/10.21873/invivo.11907 DOI

Yao Z, Zheng Z, Ke W et al (2019) Prognostic nomogram for bladder cancer with brain metastases: a National cancer database analysis. J Transl Med 17:411. https://doi.org/10.1186/s12967-019-2109-7 PubMed DOI PMC

RADES D, DZIGGEL L, MANIG L et al (2018) Predicting survival after Whole-brain irradiation for cerebral metastases in patients with cancer of the bladder. Vivo 32:633–636. https://doi.org/10.21873/invivo.11285 DOI

Fokas E, Henzel M, Engenhart-Cabillic R (2010) A comparison of radiotherapy with radiotherapy plus surgery for brain metastases from urinary bladder cancer. Strahlenther Onkol 186:565–571. https://doi.org/10.1007/s00066-010-2159-5 PubMed DOI

Önder T, Karaçin C, Kekilli E et al (2024) Predicting survival after brain metastases in patients with bladder cancer. J Clin Neurosci 125:146–151. https://doi.org/10.1016/j.jocn.2024.05.027 PubMed DOI

Fokas E, Henzel M, Engenhart-Cabillic R (2011) Erratum to: strahlentherapie und onkologie, 186 (10). Strahlenther Onkol 187:267–267. https://doi.org/10.1007/s00066-011-7159-6 DOI

Izard MA, Moutrie V, Rogers JM et al (2019) Volume not number of metastases: gamma knife radiosurgery management of intracranial lesions from an Australian perspective. Radiother Oncol 133:43–49. https://doi.org/10.1016/j.radonc.2018.12.018 PubMed DOI