
==== Front
Neurooncol Adv
Neurooncol Adv
noa
Neuro-Oncology Advances
2632-2498
Oxford University Press US

10.1093/noajnl/vdae090.100
vdae090.100
Final Category: Radiation Therapy Advances
AcademicSubjects/MED00300
AcademicSubjects/MED00310
RADT-04 IMPROVED SURVIVAL IN PATIENTS WITH RADIONECROSIS VS. LOCAL RECURRENCE AFTER STEREOTACTIC RADIOSURGERY FOR BRAIN METASTASES
Leng Jim Duke University, Durham/NC, USA

Arshad Muzamil University of Chicago, Chicago/IL, USA

Carpenter David Wellstar Paulding Hospital, Hiram/GA, USA

Qazi Jamiluddin Duke University, Durham/NC, USA

Huang Christina Duke University, Durham/NC, USA

Vaios Eugene Duke University, Durham/NC, USA

Reitman Zachary Duke University, Durham/NC, USA

Floyd Scott Duke University, Durham/NC, USA

Kirkpatrick John Duke University, Durham/NC, USA

Fecci Peter Duke University, Durham/NC, USA

Chmura Steven University of Chicago, Chicago/IL, USA

Hong Julian University of California, San Francisco, San Francisco/CA, USA

Sperduto Paul Duke University, Durham/NC, USA

Salama Joseph Duke University, Durham/NC, USA

Mullikin Trey Duke University, Durham/NC, USA

8 2024
02 8 2024
02 8 2024
6 Suppl 1 2024 SNO/ASCO CNS Metastases Conference i30i30
© The Author(s) 2024. Published by Oxford University Press, the Society for Neuro-Oncology and the European Association of Neuro-Oncology.
2024
https://creativecommons.org/licenses/by-nc/4.0/ This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

Abstract

PURPOSE: Radionecrosis (RN) is a dose-limiting toxicity after stereotactic radiosurgery (SRS) for brain metastases. How RN affects patient outcomes following SRS is not well described. Therefore, we characterized survival outcomes of patients who develop RN versus treated tumor recurrence in the absence of out-of-field intracranial progression after SRS. METHODS: This cohort study included patients completing an initial course of SRS from 2015-2020 at two institutions. Primary outcome was overall survival (OS) by presence of RN or treated tumor recurrence (LR), analyzed via the Kaplan-Meier method. Binomial logistic regression tested parameters associated with RN or LR. RESULTS: 1383 patients were included, 55% were male and median age was 63.4 years. Common primaries were lung (55%), breast (15%), and melanoma (9%). At a median follow up of 8.7 months, concern for intracranial progression was limited to irradiated sites for 143 patients (10%) - 96 with RN and 47 with LR. LR was diagnosed sooner after SRS than RN (median 5.8 vs. 8.3 months, P=0.0087), and patients with LR had significantly worse OS compared to RN (median 15.2 vs. 40.4 months, P<0.001). Patients who were symptomatic had LR and RN earlier than asymptomatic patients and had worse OS. On binomial logistic regression, RN was associated with single fraction SRS (odds ratio [OR] = 0.38, P = 0.012), receipt of immunotherapy after SRS (OR = 0.32, P < 0.014), and a longer interval from SRS (OR = 0.94, P = 0.028). CONCLUSION: In this multi-institutional cohort study of patients with brain metastasis treated with SRS, those with RN had significantly better OS vs. those with LR, with a median OS of 40.4 months vs. 15.2 months (P<0.001). This data informs the surveillance and prognosis of patients after SRS.
==== Body
pmc
