• Ali Haluk Düzkalir, Yavuz Samanci, Cheng-Chia Lee, Huai-Che Yang, Ajay Niranjan, L Dade Lunsford, Zhishuo Wei, Priyanka N Srinivasan, Samantha Dayawansa, Jason P Sheehan, Samir Patel, David Mathieu, Brad E Zacharia, Brandon Santhumayor, Douglas Kondziolka, and Selcuk Peker.
• 1Department of Neurosurgery, Gamma Knife Center, Koc University Hospital, Istanbul.
• J. Neurosurg. 2024 Nov 1; 141 (5): 132413311324-1331.

ObjectiveAccounting for approximately 15% of primary liver cancers and 3% of gastrointestinal malignancies, cholangiocarcinoma (CCA) poses a serious health concern given its high mortality rate. Managing brain metastases (BMs) from CCA is challenging because of their rarity and poor prognosis, with little guidance on treatment from the literature. In this study, the authors aimed to evaluate the safety and efficacy of stereotactic radiosurgery (SRS) in managing BMs from CCA.MethodsThis multicenter retrospective study included 13 CCA patients with 41 BMs treated with SRS from October 2006 to April 2022 at eight institutions affiliated with the International Radiosurgery Research Foundation. Inclusion criteria were a CCA diagnosis, an age over 18 years, no other malignancies, single-fraction SRS treatment for BMs, and at least one follow-up image. Data on demographics, tumor characteristics, treatment details, and outcomes were collected. The primary endpoints were local control (LC), intracranial progression-free survival (PFS), and overall survival (OS). The secondary endpoint was the development of adverse radiation effects (AREs).ResultsThe median radiological follow-up was 5 months (range 1-18 months). At the last follow-up, LC was achieved in 39 (95.1%) of 41 BMs. New distant metastases were observed in 3 patients (23.1%), and the mean intracranial PFS was 9.4 months (95% CI 6.5-12.3 months). Six-month and 1-year OS rates were 38.5% and 11.5%, respectively, and the median OS was 6 months (95% CI 4.9-7.2 months). Concurrent immunotherapy was associated with a high risk of local failure (HR 29.665, 95% CI 1.799-489.206, p = 0.018), and the absence of systemic chemotherapy before SRS was linked to reduced OS (HR 6.658, 95% CI 1.173-37.776, p = 0.032). Regarding AREs, only 1 patient (7.7%) experienced right hemiparesis and was treated with corticosteroid therapy.ConclusionsSRS is an effective option for managing BMs in CCA patients, showing promise in LC and a high safety profile.

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