Background In this study, we use a competing risks analysis to assess factors predictive of early-salvage whole brain radiotherapy (WBRT) and early death after upfront stereotactic radiosurgery (SRS) alone for brain metastases in an attempt to identify populations that benefit less from upfront SRS. Patients and methods Patients from eight academic centers were treated with SRS for brain metastasis. Competing risks analysis was carried out for distant brain failure (DBF) versus death prior to DBF as well as for salvage SRS versus salvage WBRT versus death prior to salvage. Linear regression was used to determine predictors of the number of brain metastases at initial DBF (nDBF). Results A total of 2657 patients were treated with upfront SRS alone. Multivariate analysis (MVA) identified an increased hazard of DBF associated with increasing number of brain metastases (P < 0.001), lowest SRS dose received (P < 0.001), and melanoma histology (P < 0.001), while there was a decreased hazard of DBF associated with increasing age (P < 0.001), KPS < 70 (P < 0.001), and progressive systemic disease (P = 0.004). MVA for first salvage SRS versus WBRT versus death prior to salvage revealed an increased hazard of first salvage WBRT seen with increasing number of brain metastases (P < 0.001) and a decreased hazard with widespread systemic disease (P = 0.002) and increasing age (P < 0.001). Variables associated with nDBF included age (P = 0.02), systemic disease status (P = 0.03), melanoma histology (P = 0.05), and initial number of brain metastases (P < 0.001). Conclusions Patients with a higher initial number of brain metastases were more likely to experience DBF, have a higher nDBF, and receive early-salvage WBRT, while patients who were older, had lower KPS, or had more systemic disease were more likely to experience death prior to DBF or salvage WBRT.

中文翻译：

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无需全脑放疗进行脑转移的前期放射外科手术后远距离脑衰竭和抢救方式的多机构竞争风险分析。

背景技术在这项研究中，我们使用竞争风险分析来评估预测仅因前瞻性立体定向放射外科手术（SRS）进行脑转移的早期抢救性全脑放疗（WBRT）和早期死亡的因素，以试图找出受益较少的人群SRS。患者和方法来自八个学术中心的患者接受了SRS的脑转移治疗。针对远距脑衰竭（DBF）与DBF之前的死亡以及抢救性SRS与抢救WBRT与抢救之前的死亡进行了竞争风险分析。线性回归用于确定初始DBF（nDBF）时脑转移数量的预测因子。结果共有2657例患者接受了单独的前期SRS治疗。多变量分析（MVA）发现，DBF的危险性增加与脑转移的数量增加（P <0.001），最低SRS剂量（P <0.001）和黑色素瘤组织学（P <0.001）有关，而DBF的危险性降低了DBF与年龄增长有关（P <0.001），KPS <70（P <0.001）和进行性全身疾病（P = 0.004）。首次抢救SRS，WBRT与抢救前死亡的MVA显示，随着脑转移数目的增加（P <0.001），首次抢救WBRT的危险增加，而广泛的全身性疾病（P = 0.002）和年龄的增加（P <0.001）。与nDBF相关的变量包括年龄（P = 0.02），全身性疾病状态（P = 0.03），黑色素瘤组织学（P = 0.05）和脑转移的初始数目（P <0.001）。