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<p>To evaluate outcomes and prognostic factors in patients with resected brain metastases treated with postoperative SRS/SRT, and to develop a novel overall survival (OS) prognostic model. We retrospectively analyzed 70 patients (72 lesions) treated with postoperative SRS/SRT from July 2017 to May 2024. Outcomes included in-field and out-field intracranial progression-free survival (PFS), OS, and incidence of radionecrosis. Prognostic factors were identified using Cox regression. Recursive Partitioning Analysis (RPA) was used to construct an OS model. Median follow-up was 15.1&#xa0;months. In-field PFS was 96.2% and 90.2%; Out-field PFS was 69.3% and 64.4% at 1 and 2&#xa0;years respectively. Prior cranial radiotherapy was associated with worse out-field PFS. OS rates were 67.5% at 1&#xa0;year, 46.7% at 2&#xa0;years. ECOG performance status, time from surgery to radiotherapy of ≤ 56&#xa0;days and biologically effective dose using α/ß of 10 (BED<sub>10</sub>) ≥ 51&#xa0;Gy were significant OS predictors. Radionecrosis occurred in 7 patients (10%) with median onset at 25.0&#xa0;months. The novel RPA model stratified patients into 3 groups: RPA-I (ECOG &lt; 2 &amp; BED<sub>10</sub> ≥ 51&#xa0;Gy; median OS 43.4&#xa0;months, 95% CI 22.3&#xa0;months–Not reached), RPA-II (ECOG &lt; 2 &amp; BED<sub>10</sub> &lt; 51&#xa0;Gy; median OS 11.9&#xa0;months, 95% CI 3&#xa0;months–19.2&#xa0;months) and RPA-III (ECOG ≥ 2 regardless of BED<sub>10</sub> delivered; median OS 4.1&#xa0;months, 95% CI 1.2&#xa0;months – 22.0&#xa0;months) (<i>p</i> &lt; 0.001). RPA-II and RPA-III had higher death risk compared with RPA-I. This model outperformed existing models after bootstrapping validation. Postoperative SRS/SRT is effective for brain metastases. Appropriate patient selection, timely initiation and sufficient radiation dose improve outcomes. Our novel RPA model offers promising prognostic stratification for guiding treatment decisions.</p>

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Postoperative stereotactic radiotherapy for brain metastases: results from a single-center retrospective analysis

  • 期刊论文

  • 发表日期：

    2025年10月17日

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  • E. K. M. Lam,
  • D. K. C. Leung,
  • V. H. F. Lee,
  • B. B. T. Taw,
  • L. F. Li,
  • G. Ho,
  • H. C. W. Choi,
  • B. M. F. Cheung,
  • J. S. C. Cheung,
  • Y. P. Ng,
  • M. Y. Luk,
  • K. K. Yuen

摘要

To evaluate outcomes and prognostic factors in patients with resected brain metastases treated with postoperative SRS/SRT, and to develop a novel overall survival (OS) prognostic model. We retrospectively analyzed 70 patients (72 lesions) treated with postoperative SRS/SRT from July 2017 to May 2024. Outcomes included in-field and out-field intracranial progression-free survival (PFS), OS, and incidence of radionecrosis. Prognostic factors were identified using Cox regression. Recursive Partitioning Analysis (RPA) was used to construct an OS model. Median follow-up was 15.1 months. In-field PFS was 96.2% and 90.2%; Out-field PFS was 69.3% and 64.4% at 1 and 2 years respectively. Prior cranial radiotherapy was associated with worse out-field PFS. OS rates were 67.5% at 1 year, 46.7% at 2 years. ECOG performance status, time from surgery to radiotherapy of ≤ 56 days and biologically effective dose using α/ß of 10 (BED10) ≥ 51 Gy were significant OS predictors. Radionecrosis occurred in 7 patients (10%) with median onset at 25.0 months. The novel RPA model stratified patients into 3 groups: RPA-I (ECOG < 2 & BED10 ≥ 51 Gy; median OS 43.4 months, 95% CI 22.3 months–Not reached), RPA-II (ECOG < 2 & BED10 < 51 Gy; median OS 11.9 months, 95% CI 3 months–19.2 months) and RPA-III (ECOG ≥ 2 regardless of BED10 delivered; median OS 4.1 months, 95% CI 1.2 months – 22.0 months) (p < 0.001). RPA-II and RPA-III had higher death risk compared with RPA-I. This model outperformed existing models after bootstrapping validation. Postoperative SRS/SRT is effective for brain metastases. Appropriate patient selection, timely initiation and sufficient radiation dose improve outcomes. Our novel RPA model offers promising prognostic stratification for guiding treatment decisions.