F.02 Towards the complete control of brain metastases using surveillance screening and stereotactic radiosurgery

Abstract

Background: The incidence of brain metastases is increasing with the development of improved systemic therapies with limited impact on intracranial disease. The purpose of this study was to determine if there is a threshold tumor size below which local control (LC) rates approach 100% after stereotactic radiosurgery (SRS). Methods: 200 patients with 1237 tumors were identified from a prospective registry of patients having undergone SRS between 2012-2014. Histology consisted predominantly of non-small cell lung cancer (NSCLC), melanoma and breast cancer. Results: The median tumor size was 6 mm in diameter or 70 mm³ and most commonly NSCLC. Thirty-three tumors had local progression at a median time of 8.8 months. The 1- and 2-year actuarial LC for all tumors were 97% and 93%. LC of 100% was seen for intracranial metastases less than 100 mm³ or 6 mm in diameter, independent of histology. Total tumor volume was an independent predictor of overall survival, after adjusting for age, KPS and extracranial disease status. Conclusions: SRS can achieve LC rates approaching 100% for subcentimeter metastases. The earlier detection and prompt treatment of small intracranial metastases may prevent the development of neurological symptoms, the need for surgical resection, and potentially improve overall survival. The results of this study would favour the implementation of routine staging MRIs.