This study aims to evaluate whether SRS is an effective treatment approach for patient with 5-15 brain mets. This retrospective review 2083 patients who underwent Gamma Knife SRS as the initial treatment modality for intracranial metastases at 8 academic institutions between 1991 and 2013.

Compared with the 2 to 4 BM group, 5 to 15 BM was not associated with an increased hazard of death.

Predictors of Distant Brain Failure on multivariable analyses included age 65 years or greater, other histology, margin dose, 1 versus 2 to 4 BM and 5 to 15 versus 2 to 4 BM.

Several clinical outcomes differed between the 2 to 4 and 5 to 15 BM groups, such as cumulative incidence of Distant Brain Failure and Brain Metastasis Velocity, both of which were higher in patients with 5 to 15 BM. However, these differences did not translate into more patients with 5 to 15 BM requiring salvage therapy.

Bottom line: The present study confirms, in a North American population, findings from the Japanese multi-institutional study that patients with 2 to 4 BM do not have a significantly worse survival than patients with 5 or greater.  

The number of BM probably should not be used alone to determine the choice of initial SRS versus WBRT in the management of BM.

Prospective trials are needed to validate this finding.

Reference (PubMed Link): Hughes RT, Masters AH, McTyre ER, et al. Initial srs for patients with 5 to 15 brain metastases: Results of a multi-institutional experience. Int J Radiat Oncol Biol Phys 2019;104:1091-1098.

Key Institution: Multi-Institutional (Wake Forest School of Medicine)
Keywords: SRS, Brain Metastasis 

Long term outcomes and side effects from radiation therapy in young patients is of utmost importance. This study looked at neuropsychological and neuroendocrine outcomes pre- and post- radiation therapy for benign or low-grade CNS tumors.  The study from Tata Memorial Centre in Mumbai showed that stereotactic RT achieved superior outcomes compared to conventional RT without compromising survival.  This is an important step towards quality of life improvement for young RT patients.

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Journal & Date: JAMA Oncology. 2017 Oct 1;3(10):1368-1376.
Key Institution: Tata Memorial Centre, Mumbai, India
Keywords: Stereotactic, Radiotherapy, Brain Tumors, Toxicity, Quality of Life, Clinical Trial