INTRODUCTION Stereotactic radiosurgery (SRS) is an emerging treatment for patients with multiple brain metastases (BM). The present work compares the SRS of multiple brain metastases with whole-brain radiotherapy (WBRT). METHODS We performed a matched-pair analysis for 128 patients with multiple BM treated with either SRS or WBRT over a 5-year period. Patients were matched pairwise for seven potential prognostic factors. A mixed Cox Proportional Hazards model with univariate and multivariate analysis was fitted for overall survival (OS). Distant intracranial progression-free survival (icPFS) and local control were assessed using a Fine and Gray subdistribution hazard model and considering death as competing event. RESULTS Patients undergoing SRS had a median of 4 BM (range 3-16). 1-year local control of individual BM following SRS was 91.7%. Median OS in the SRS subgroup was 15.7 months (IQR 9.7-36.4) versus 8.0 months (interquartile range, IQR 3.8-18.0) in the WBRT subgroup (HR 2.25, 95% CI [1.5; 3.5], p < 0.001). Median icPFS was 8.6 (IQR 3.4-18.0) versus 22.4 (IQR 5.6-28.6) months, respectively (HR for WBRT 0.41, 95% CI [0.24; 0.71], p = 0.001). Following SRS, synchronous BM diagnosis (HR 2.51, 95% CI [1.30; 4.70], p = 0.004), higher initial number of BM (HR 1.21, 95% CI [1.10; 1.40], p = 0.002) and lung cancer histology (HR 2.05, 95% CI [1.10; 3.80], p = 0.024) negatively impacted survival. Excellent clinical performance (KPI 90%) was a positive prognosticator (HR 0.38, 95% CI [0.20; 0.72], p = 0.003), as was extracerebral tumor control (HR 0.48, 95% CI [0.24; 0.97], p = 0.040). Higher initial (HR 1.19, 95% CI [1.00; 1.40], p < 0.013) and total number of BM (HR 1.23, 95% CI [1.10; 1.40], p < 0.001) were prognostic for shorter icPFS. CONCLUSION This is the first matched-pair analysis to compare SRS alone versus WBRT alone for multiple BM. OS was prolonged in the SRS subgroup and generally favorable in the entire cohort. Our results suggest SRS as a feasible and effective treatment for patients with multiple BM.

中文翻译：

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配对分析比较了多发性脑转移患者的立体定向放射外科手术与全脑放射治疗。

简介立体定向放射外科手术（SRS）是针对多发性脑转移（BM）患者的新兴治疗方法。目前的工作比较了全脑放疗（WBRT）的多发性脑转移的SRS。方法我们对5年来用SRS或WBRT治疗的128例多发性BM患者进行了配对分析。将患者按配对配对以评估七个潜在的预后因素。将具有单变量和多变量分析的混合Cox比例危险模型拟合为整体生存率（OS）。使用Fine和Gray子分布危害模型并考虑死亡为竞争事件，评估了远处的颅内无进展生存期（icPFS）和局部控制。结果接受SRS的患者中位数为4 BM（范围3-16）。SRS后1年的局部BM局部控制率为91.7％。SRS亚组的中位OS为15.7个月（IQR 9.7-36.4），而WBRT亚组为8.0个月（四分位间距，IQR 3.8-18.0）（HR 2.25，95％CI [1.5; 3.5]，p <0.001）。icPFS中位数分别为8.6（IQR 3.4-18.0）个月和22.4（IQR 5.6-28.6）个月（WBRT的心率0.41，95％CI [0.24; 0.71]，p = 0.001）。SRS后，同步进行BM诊断（HR 2.51，95％CI [1.30; 4.70]，p = 0.004），更高的BM初始数目（HR 1.21，95％CI [1.10; 1.40]，p = 0.002）和肺癌组织学（HR 2.05，95％CI [1.10; 3.80]，p = 0.024）对生存率产生负面影响。出色的临床表现（KPI 90％）是阳性的预后指标（HR 0.38，95％CI [0.20; 0.72]，p = 0.003），以及脑外肿瘤对照（HR 0.48，95％CI [0.24; 0.97]，p = 0.040）。较高的初始值（HR 1.19，95％CI [1.00; 1.40]，p <0.013）和BM总数（HR 1.23，95％CI [1.10; 1.40]，p <0.001）预后较短的icPFS。结论这是首次对多个BM比较单独SRS与单独WBRT的匹配对分析。在SRS亚组中OS延长了，并且在整个队列中总体上是有利的。我们的结果表明，对于多发性骨髓病，SRS是一种可行且有效的治疗方法。