1. Stereotactic Radiosurgery for Patients with Brain Metastases from Hepatopancreaticobiliary Cancers.
- Author
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Wei, Zhishuo, Srinivasan, Priyanka, Patel, Ritam, Bednarz, Greg, Flickinger, John C., Hadjipanayis, Constantinos G., Niranjan, Ajay, and Lunsford, L. Dade
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CHOLANGIOCARCINOMA , *LIFE expectancy , *KARNOFSKY Performance Status , *RADIOSURGERY , *TREATMENT effectiveness , *RETROSPECTIVE studies , *CANCER patients , *DESCRIPTIVE statistics , *PANCREATIC tumors , *METASTASIS , *LONGITUDINAL method , *QUALITY of life , *MEDICAL records , *ACQUISITION of data , *RADIATION doses , *COMPARATIVE studies , *CANCER patient psychology , *HEPATOCELLULAR carcinoma , *BRAIN tumors , *DISEASE progression , *OVERALL survival , *DISEASE complications - Abstract
Simple Summary: Brain metastases from Hepatopancreaticobiliary (HPB) cancers are extremely rare and indicate a very poor prognosis. Patients with HPB cancers often have several months of life expectancy from the diagnosis of the brain metastases. Due to the rarity, there is no established protocol on how to treat brain metastases from HPB malignancies. Stereotactic radiosurgery provides the advantage of out-patient noninvasive management of brain metastases. We aim to retrospectively review the post-SRS outcomes of HPB patients with brain metastases in search for the optimal radiation delivery dose for HPB brain metastases. Our study showed that SRS could achieve a 94.7% local tumor control rate per tumor and newly developed brain metastases could be treated with repeat SRS. The favorable outcome of the present study indicates that SRS is effective in controlling HPB brain metastases and is instrumental in preserving patients' quality of life. Background: The role of stereotactic radiosurgery (SRS) for patients with brain metastases from hepatopancreaticobiliary (HPB) cancers has yet to be established. The authors present a single-institution experience of patients with HPB cancers who underwent SRS when their cancer spread to the brain. Methods: We surveyed our Gamma Knife SRS data base of 18,000 patients for the years 1987–2022. In total, 19 metastatic HPB cancer patients (13 male) with 76 brain metastases were identified. The median age at SRS was 61 years (range: 48–83). The primary cancer sites were hepatocellular carcinoma (HCC, 11 patients), cholangiocarcinoma (CCC, 2 patients), and pancreatic carcinoma (PCC, 6 patients). The median Karnofsky Performance Score (KPS) was 80 (range: 50–90). Two patients underwent pre-SRS whole-brain fractionated radiation therapy (WBRT) and eight patients underwent pre-SRS surgical resection. All SRS was delivered in single session. The median margin dose was 18 Gy (range: 15–20). The median cumulative tumor volume was 8.1 cc (range: 1.0–44.2). Results: The median patient overall survival (OS) after SRS was 7 months (range 1–79 months). Four patients had documented local tumor progression after SRS at a median time of 8.5 months (range: 2–15) between SRS and progression. Out of 76 treated tumors, 72 tumors exhibited local control. The local tumor control rate per patient was 78.9%. The local tumor control per tumor was 94.7%. Four patients developed new brain metastases at a median of 6.5 months (range: 2–17) after SRS. No patient experienced adverse radiation effects (AREs). At the last follow-up, 18 patients had died, all from systemic disease progression. Conclusions: Metastatic spread to the brain from HPB cancers occurs late in the course of the primary disease. In this study, all deceased patients ultimately died from primary disease progression. SRS is a non-invasive strategy that maximally preserves quality of life, and our results reported favorable outcomes compared to the existing literature. SRS should be considered as one of the primary management strategies for patients with brain metastatic spread from HPB cancer. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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