Wei Chris Z, Shanahan Regan, Puccio David, Deng Hansen, Lee Cheng-Chia, Yang Huai-Che, Cifarelli Christopher P, Hack Joshua D, Cifarelli Daniel T, Peker Selcuk, Samanci Yavuz, Mathieu David, Blanchard Jocelyn, Perlow Haley K, Palmer Joshua D, Tripathi Manjul, Moreno Nuria Martínez, Martínez Álvarez Roberto, Speckter Herwin, Hernandez Wenceslao, Liščák Roman, May Jaromir, Elhamdani Shahed, Shepard Matthew J, Wegner Rodney, Hadjipanayis Constantinos G, Lunsford L Dade, Niranjan Ajay
School of Medicine, University of Pittsburgh Medical Center, Pennsylvania, PA, USA.
Center for Image-Guided Neurosurgery, University of Pittsburgh Medical Center, Pennsylvania, PA, USA.
J Neurooncol. 2025 Jun 3. doi: 10.1007/s11060-025-05093-y.
Whether the number or cumulative volume of brain metastases affects survival in patients with metastatic non-small cell lung cancer (NSCLC) remains controversial. We conducted a volume matched multi-center study to determine whether patients with a single metastasis had better outcomes than patients with > 20 brain metastases.
Between 2014 and 2022, 317 NSCLC patients (21.14% female; single tumor: 278 patients; >20 tumors, 39 patients) underwent stereotactic radiosurgery (SRS). The prescribed margin dose, cumulative tumor volume, 12 Gy volume, and concurrent systematic disease managements were recorded. The overall survival (OS), local tumor control (LTC), adverse radiation effect (ARE) risk, and new tumor development were compared.
No difference in OS was found between patients with > 20 brain metastases and patients with a single metastasis (p = 0.61). Compared to the single tumor cohort, where 217 of 278 (78.06%) patients had no recorded local tumor progression, patients with > 20 brain metastases had a local tumor control rate of 76.92% (p = 0.25). Patients with > 20 tumors had a significantly higher rate of distant tumor development (69.2%) after SRS compared to patients with single tumors (35.3%; **p = 0.024). No significant difference of ARE rate was found.
In this volume matched multi-center study, patients with > 20 tumors showed comparable OS and LTC outcomes compared to patients with single tumors. The number of brain metastases should not be used as a criteria to exclude patients from receiving SRS.
脑转移瘤的数量或累积体积是否会影响转移性非小细胞肺癌（NSCLC）患者的生存仍存在争议。我们进行了一项体积匹配的多中心研究，以确定单发转移瘤患者的预后是否优于脑转移瘤超过20个的患者。
2014年至2022年期间，317例NSCLC患者（女性占21.14%；单发肿瘤：278例患者；肿瘤超过20个：39例患者）接受了立体定向放射外科治疗（SRS）。记录规定的边缘剂量、累积肿瘤体积、12 Gy体积以及同时进行的全身疾病管理情况。比较总生存期（OS）、局部肿瘤控制（LTC）、放疗不良反应（ARE）风险和新肿瘤发生情况。
脑转移瘤超过20个的患者与单发转移瘤患者的OS无差异（p = 0.61）。与单发肿瘤队列相比，278例患者中有217例（78.06%）未记录到局部肿瘤进展，脑转移瘤超过20个的患者局部肿瘤控制率为76.92%（p = 0.25）。与单发肿瘤患者（35.3%）相比，肿瘤超过20个的患者在SRS后远处肿瘤发生率显著更高（69.2%；**p = 0.024）。ARE发生率无显著差异。
在这项体积匹配的多中心研究中，肿瘤超过20个的患者与单发肿瘤患者的OS和LTC结果相当。脑转移瘤的数量不应作为排除患者接受SRS的标准。
