• Mir Amaan Ali, Brian R Hirshman, Bayard Wilson, Kate T Carroll, James A Proudfoot, Steven J Goetsch, John F Alksne, Kenneth Ott, Hitoshi Aiyama, Osamu Nagano, Bob S Carter, Gerald Fogarty, Angela Hong, Toru Serizawa, Masaaki Yamamoto, and Clark C Chen.
• Center for Translational and Applied Neuro-Oncology, Department of Neurosurgery, University of California, San Diego, La Jolla, California, USA.
• World Neurosurg. 2017 Nov 1; 107: 944-951.e1.

BackgroundThe number of brain metastases (BMs) plays an important role in the decision between stereotactic radiosurgery (SRS) and whole-brain radiation therapy.MethodsWe analyzed the survival of 5750 SRS-treated patients with BM as a function of BM number. Survival analyses were performed with Kaplan-Meier analysis as well as univariate and multivariate Cox proportional hazards models.ResultsPatients with BMs were first categorized as those with 1, 2-4, and 5-10 BMs based on the scheme proposed by Yamamoto et al. (Lancet Oncology 2014). Median overall survival for patients with 1 BM was superior to those with 2-4 BMs (7.1 months vs. 6.4 months, P = 0.009), and survival of patients with 2-4 BMs did not differ from those with 5-10 BMs (6.4 months vs. 6.3 months, P = 0.170). The median survival of patients with >10 BMs was lower than those with 2-10 BMs (6.3 months vs. 5.5 months, P = 0.025). In a multivariate model that accounted for age, Karnofsky Performance Score, systemic disease status, tumor histology, and cumulative intracranial tumor volume, we observed a ∼10% increase in hazard of death when comparing patients with 1 versus 2-10 BMs (P < 0.001) or 10 versus >10 BMs (P < 0.001). When BM number was modeled as a continuous variable rather than using the classification by Yamamoto et al., we observed a step-wise 4% increase in the hazard of death for every increment of 6-7 BM (P < 0.001).ConclusionsThe contribution of BM number to overall survival is modest and should be considered as one of the many variables considered in the decision between SRS and whole-brain radiation therapy.Copyright © 2017 Elsevier Inc. All rights reserved.

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