Factors associated with the use of salvage whole brain radiation therapy versus salvage stereotactic radiosurgery after initial stereotactic radiosurgery for brain metastases

Yash S Soni; Benjamin J Rich; Deukwoo Kwon; Wei Zhao; Danny L John; Crystal Seldon; Jessica Meshman; Ronald Benveniste; Ricardo J Komotar; Macarena de la Fuente; Maria Del Pilar Guillermo Prieto; Gregory Azzam; Eric A Mellon; Carolina G Benjamin; Tejan Diwanji

Factors associated with the use of salvage whole brain radiation therapy versus salvage stereotactic radiosurgery after initial stereotactic radiosurgery for brain metastases

J Radiosurg SBRT. 2022;8(2):85-94.

Authors

Yash S Soni¹, Benjamin J Rich², Deukwoo Kwon³, Wei Zhao³, Danny L John¹, Crystal Seldon², Jessica Meshman², Ronald Benveniste⁴, Ricardo J Komotar⁴, Macarena de la Fuente⁵, Maria Del Pilar Guillermo Prieto⁵, Gregory Azzam², Eric A Mellon², Carolina G Benjamin⁴, Tejan Diwanji^{2

6}

Affiliations

¹ University of Miami Miller School of Medicine, Miami, FL, USA.
² Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, USA.
³ Department of Public Health Sciences, Biostatistics and Bioinformatics Shared Resource, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
⁴ Department of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA.
⁵ Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA.
⁶ Department of Radiation Oncology, Mid-Atlantic Permanente Medical Group, Halethorpe, MD, USA.

PMID: 36275132
PMCID: PMC9489072

Abstract

Objectives: Patients undergoing stereotactic radiosurgery (SRS) for brain metastases require additional radiation for relapse. Our objective is to determine the factors associated with salvage SRS versus whole brain radiation therapy (WBRT) for salvage of first intracranial failure (ICF) after upfront SRS.

Method: We identified a cohort of 110 patients with brain metastases treated with SRS in the definitive or postoperative setting followed by subsequent salvage WBRT or SRS at least one month after initial SRS. Clinical and demographic characteristics were retrospectively recorded.

Results: 78 Patients received SRS and 32 patients received WBRT at the time of first ICF. On multivariate analysis (MVA) factors associated with decreased use of salvage SRS were male gender (p=0.044) and local progression (p<0.001).

Conclusions: Local progression and male gender were the strongest factors associated with selection of salvage WBRT. Possible etiologies of this difference could be provider or patient driven, but warrant further exploration.

Keywords: Stereotactic radiosurgery; brain metastases; disparities; salvage radiation; whole brain radiation.