BACKGROUND: There is a paucity of data on treatment outcomes following stereotactic radiosurgery (SRS) for brain metastases from sarcoma primaries. METHODS: The International Radiosurgery Research Foundation member-sites were queried for patients with brain metastases from sarcoma primaries treated with SRS. Overall survival (OS) and local control (LC) were calculated via Kaplan-Meier analysis. Univariate analyses examined prognostic factors associated with LC and OS via log-rank t-tests and multivariate analyses (MVA) via Cox proportional hazards model. RESULTS: A total of 146 patients with 309 brain metastases were identified. Two-hundred and thirty lesions were treated with single-fraction SRS with a median dose of 20 Gy (15-24 Gy). Ninety-five patients had extracranial metastases, including 75 oligometastatic patients. One- and 2-year OS and LC rates were 47.7% and 37.3%, and 78.3% and 62.2%, respectively. On univariate analyses, superior 1-year OS was noted among leiomyosarcomas (69.7% vs. 42.6%; p = .02) with poorer outcomes among pleomorphic histologies (10.5% vs. 50.7%; p = .002). Pleomorphic histologies were associated with poorer OS on MVA (hazard ratio [HR], 3.13; p = .006). On MVA, LC was inferior among patients of age ≥45 years (HR, 3.78; p < .001) and superior among leiomyosarcomas (HR, 0.31; p = .03). OS was prognosticated based on adverse factors (ie, nonleiomyosarcoma histology and progressive extracranial metastases). Two-year OS for patients with and without adverse features were 78.6% and 31.5%, respectively. CONCLUSIONS: LC outcomes were driven by histology and age with superior LC among leiomyosarcomas and patients of age <45 years. OS was driven by nonleiomyosarcoma histology and the presence of progressive extracranial disease.

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

Department of Neurological Surgery University of Virginia Charlottesville Virginia USA

Department of Neurosurgery Allegheny Health Network Pittsburgh Pennsylvania USA

Department of Neurosurgery and Radiation Oncology University of Miami Miami Florida USA

Department of Neurosurgery Cleveland Clinic Foundation Cleveland Ohio USA

Department of Neurosurgery Dokkyo Medical University Mibu Tochigi Japan

Department of Neurosurgery Humanitas Research Hospital IRCCS Milan Italy

Department of Neurosurgery Koc University School of Medicine Istanbul Turkey

Department of Neurosurgery Neurological Institute Taipei Veteran General Hospital Taipei Taiwan

Department of Neurosurgery NYU Langone New York New York USA

Department of Neurosurgery Penn State Hershey Medical Center Hershey Pennsylvania USA

Department of Neurosurgery University of Alberta Edmonton Alberta Canada

Department of Neurosurgery University of Miami Miami Florida USA

Department of Neurosurgery University of Southern California Los Angeles California USA

Department of Neurosurgery West Virginia University Morgantown West Virginia USA

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

Department of Radiation Oncology Allegheny Health Network Cancer Institute Allegheny Health Network Pittsburgh Pennsylvania USA

Department of Radiation Oncology Massey Comprehensive Cancer Center Virginia Commonwealth University Health System Richmond Virginia USA

Department of Radiation Oncology NYU Langone New York New York USA

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

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

Division of Neurosurgery Department of Surgery Université de Sherbrooke Centre de recherche du CHUS Sherbrooke Quebec Canada

Dominican Gamma Knife Center and Radiology Department CEDIMAT Santo Domingo DR

School of Medicine National Yang Ming Chiao Tung University Taipei Taiwan

Vivian L Smith Department of Neurosurgery University of Texas Science Center at Houston Houston Texas USA

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