• Diandra N Ayala-Peacock, Ann M Peiffer, John T Lucas, Scott Isom, J Griff Kuremsky, James J Urbanic, J Daniel Bourland, Adrian W Laxton, Stephen B Tatter, Edward G Shaw, and Michael D Chan.
• Department of Radiation Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina (D.N.A.-P., A.M.P., J.T.L., J.G.K., J.J.U., J.D.B., E.G.S., M.D.C.); Department of Neurosurgery, Wake Forest School of Medicine, Winston-Salem, North Carolina (A.W.L., S.B.T.); Department of Biostatistical Sciences, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina (S.I.); Brain Tumor Center of Excellence, Wake Forest School of Medicine, Winston-Salem, North Carolina (A.M.P., J.D.B., A.W.L., S.B.T., E.G.S., M.D.C.).
• Neuro-oncology. 2014 Sep 1; 16 (9): 1283-8.

BackgroundWe review our single institution experience to determine predictive factors for early and delayed distant brain failure (DBF) after radiosurgery without whole brain radiotherapy (WBRT) for brain metastases.Materials And MethodsBetween January 2000 and December 2010, a total of 464 patients were treated with Gamma Knife stereotactic radiosurgery (SRS) without WBRT for primary management of newly diagnosed brain metastases. Histology, systemic disease, RPA class, and number of metastases were evaluated as possible predictors of DBF rate. DBF rates were determined by serial MRI. Kaplan-Meier method was used to estimate rate of DBF. Multivariate analysis was performed using Cox Proportional Hazard regression.ResultsMedian number of lesions treated was 1 (range 1-13). Median time to DBF was 4.9 months. Twenty-seven percent of patients ultimately required WBRT with median time to WBRT of 5.6 months. Progressive systemic disease (χ(2)= 16.748, P < .001), number of metastases at SRS (χ(2) = 27.216, P < .001), discovery of new metastases at time of SRS (χ(2) = 9.197, P < .01), and histology (χ(2) = 12.819, P < .07) were factors that predicted for earlier time to distant failure. High risk histologic subtypes (melanoma, her2 negative breast, χ(2) = 11.020, P < .001) and low risk subtypes (her2 + breast, χ(2) = 11.343, P < .001) were identified. Progressive systemic disease (χ(2) = 9.549, P < .01), number of brain metastases (χ(2) = 16.953, P < .001), minimum SRS dose (χ(2) = 21.609, P < .001), and widespread metastatic disease (χ(2) = 29.396, P < .001) were predictive of shorter time to WBRT.ConclusionSystemic disease, number of metastases, and histology are factors that predict distant failure rate after primary radiosurgical management of brain metastases.© The Author(s) 2014. Published by Oxford University Press on behalf of the Society for Neuro-Oncology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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