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

10.1093/noajnl/vdae090.050
vdae090.050
Final Category: Multimodality Approaches
AcademicSubjects/MED00300
AcademicSubjects/MED00310
MMOD-06 IMPACT OF SYSTEMIC THERAPY TIMING AFTER STEREOTACTIC RADIOSURGERY IN PATIENTS WITH BRAIN-ONLY METASTASES
Qazi Jamiluddin Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA

Carpenter David Department of Radiation Oncology, Wellstar Paulding Hospital, Hiram, GA, USA
Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA

Broadwater Gloria Duke Cancer Institute Biostatistics, Duke University Medical Center, Durham, NC, USA

Van Swearingen Aamanda Duke Center for Brain and Spine Metastasis, Duke Cancer Institute, Durham, NC, USA
Division of Medical Oncology, Duke Cancer Institute, Durham, NC, USA

Lent Jim Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA

Arshad Muzamil Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, IL, USA

Chmura Steven Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, IL, USA

Bansal Rani Duke Center for Brain and Spine Metastasis, Duke Cancer Institute, Durham, NC, USA
Division of Medical Oncology, Duke Cancer Institute, Durham, NC, USA

Fecci Peter Duke Center for Brain and Spine Metastasis, Duke Cancer Institute, Durham, NC, USA
Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA

Kirkpatrick John Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
Duke Center for Brain and Spine Metastasis, Duke Cancer Institute, Durham, NC, USA

Alder Laura Duke Center for Brain and Spine Metastasis, Duke Cancer Institute, Durham, NC, USA
Division of Medical Oncology, Duke Cancer Institute, Durham, NC, USA

Salama Joseph Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
Radiation Oncology Clinical Service, Durham VA Healthcare System, Durham, NC, USA

Floyd Scott Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
Duke Center for Brain and Spine Metastasis, Duke Cancer Institute, Durham, NC, USA

Mullikin Trey Department of Radiation Oncology, Duke University Medical Center, Durham, NC, USA
Duke Center for Brain and Spine Metastasis, Duke Cancer Institute, Durham, NC, USA

Anders Carey Duke Center for Brain and Spine Metastasis, Duke Cancer Institute, Durham, NC, USA
Division of Medical Oncology, Duke Cancer Institute, Durham, NC, USA

8 2024
02 8 2024
02 8 2024
6 Suppl 1 2024 SNO/ASCO CNS Metastases Conference i16i16
© 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

The impact of systemic therapy (ST) on outcomes for patients with brain-only recurrence in the absence of extracranial disease (ECD) is not well established. We compared outcomes between patients with brain-only metastases (BrM) treated with stereotactic radiosurgery (SRS) who received ST ≤3 months (mos), >3mos, or not at all after SRS. We identified patients completing a course of SRS, without ECD, across two institutions from 1/2015-12/2020. Intracranial progression after SRS was determined by radiographic recurrence on brain MRI. Overall survival (OS) and intracranial progression free survival (iPFS) estimates were generated via the Kaplan-Meier method. 342 pts with brain only metastases were identified. Primary sites included lung (73%), breast (12%), and additional sites (15%) including melanoma/skin, genitourinary, gastrointestinal, head/neck, and other/unknown. Almost half, 169 (49%), received no ST, 80 (23%) received ST ≤3mos, and 93 (27%) received ST >3mos after SRS. Median age was younger in the ST >3mos cohort (60.5yo versus overall median age 65.3yo, p=0.0002). Performance status, race, and gender were not significantly different between groups. Median OS differed significantly between groups: ST ≤3mos with 24.9mos (95%CI: 16.6-51.1), ST >3mos with 27.9mos (95% CI: 20.6-37.5), and no ST after SRS with 11.0mos (95%CI: 8.9-17.5), p=0.002. Median iPFS differed significantly between groups: ST ≤3mos with 16.1mos (95% CI: 16.1-33.7), ST >3mos with 8.9mos (95% CI: 6.9 – 13.5), and no ST after SRS with 10.0mos (95% CI: 6.7- 15.1). However, iPFS was non-significant in multivariate analysis adjusting for age, performance status, metastatic burden, tumor type, and prior ST. In a multi-institutional cohort of patients with BrM, ST after SRS improves OS regardless of timing. Additionally, ST ≤3mos appears to improve iPFS compared to ST >3mos after SRS, which warrants further investigation. Appropriate patients with BrM should be routinely referred for a multi-disciplinary discussion of systemic therapy following SRS.
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