Katsos Konstantinos, Michalopoulos Giorgos, D'Ambrosio Anthony L, Cobb William S, Grills Inga S, McInerney James, Jensen Randy L, Chang Eric, Andrews David W, Pouratian Nader, Timmerman Robert, Attia Albert, Spalding Aaron C, Walter Kevin, Bydon Mohamad, Asher Anthony L, Sheehan Jason P
1Neuro-Informatics Laboratory and.
2Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota.
J Neurosurg. 2025 Jun 27:1-12. doi: 10.3171/2025.3.JNS241471.
The aim of this study was to evaluate mortality and progression outcomes in patients undergoing stereotactic radiosurgery (SRS) for breast cancer brain metastases and to identify associated risk factors using a national quality registry.
The NeuroPoint Alliance (NPA) SRS Registry was employed for this study, which conducted prospective enrollment of patients undergoing SRS at 16 participating centers from 2017 to 2024. Outcomes of interest included the post-SRS EQ-5D score change, overall survival, local progression, out-of-field progression, and overall intracranial progression. For all time-to-event analyses, Kaplan-Meier curves and multivariable Cox regressions with hazard ratios were used.
A total of 138 patients (127 female, mean age 59.8 years) were identified; 46.4% had a single lesion, 42.0% had 2-4 lesions, and 11.6% had ≥ 5 lesions, while 87.0% had a Karnofsky Performance Status (KPS) score between 80 and 100. The median overall survival was 17.9 months, and independent predictors of all-cause mortality included a KPS score ≤ 90 (HR 6.73) and diabetes mellitus (HR 3.35). The median time to local progression was 19.8 months. More than 5 lesions at baseline (HR 9.03) and a marginal dose ≤ 17.6 Gy (HR 8.00) were predictive of local recurrence. The median was not reached for out-of-field progression, and predictors included ≥ 2 lesions at the time of SRS (HR 3.20) and a marginal dose ≤ 17.6 Gy (HR 4.61). At the final follow-up assessment, 17.1% of patients experienced no change according to the EQ-5D, while 34.3% had improvement, 11.4% had mixed results, and 37.1% had worsened health. In the multivariable linear regression model, pre-SRS resection (r = 1.92) and baseline EQ-5D score (r = 1.29) were statistically significant predictors of quality of life at the final follow-up assessment.
Using real-world data from the NPA SRS Registry, this study demonstrated comparable outcomes in patients who underwent SRS for breast cancer brain metastases compared with those of previous literature. The number of lesions at the time of SRS and the marginal dose were independent risk factors for local recurrence, out-of-field progression, and overall intracranial progression. Pre-SRS resection and baseline EQ-5D score were independent predictors of quality of life following SRS.
本研究旨在评估接受立体定向放射外科治疗（SRS）的乳腺癌脑转移患者的死亡率和疾病进展结局，并利用国家质量登记处的数据确定相关危险因素。
本研究采用神经点联盟（NPA）SRS登记处的数据，该登记处对2017年至2024年期间在16个参与中心接受SRS治疗的患者进行了前瞻性登记。感兴趣的结局包括SRS后EQ-5D评分变化、总生存期、局部进展、野外进展和颅内总体进展。对于所有生存时间分析，使用了Kaplan-Meier曲线和带有风险比的多变量Cox回归。
共纳入138例患者（127例女性，平均年龄59.8岁）；46.4%有单个病灶，42.0%有2 - 4个病灶，11.6%有≥5个病灶，87.0%的卡氏功能状态（KPS）评分为80至100分。中位总生存期为17.9个月，全因死亡率的独立预测因素包括KPS评分≤90（HR 6.73）和糖尿病（HR 3.35）。局部进展的中位时间为19.8个月。基线时超过5个病灶（HR 9.03）和边缘剂量≤17.6 Gy（HR 8.00）是局部复发的预测因素。野外进展的中位时间未达到，预测因素包括SRS时≥2个病灶（HR 3.20）和边缘剂量≤17.6 Gy（HR 4.61）。在最后一次随访评估中，17.1%的患者根据EQ-5D评分无变化，34.3%有所改善，11.4%结果混合，37.1%健康状况恶化。在多变量线性回归模型中，SRS前切除（r = 1.92）和基线EQ-5D评分（r = 1.29）是最后一次随访评估时生活质量的统计学显著预测因素。
本研究利用NPA SRS登记处的真实世界数据表明，接受SRS治疗的乳腺癌脑转移患者的结局与以往文献报道的相当。SRS时的病灶数量和边缘剂量是局部复发、野外进展和颅内总体进展的独立危险因素。SRS前切除和基线EQ-5D评分是SRS后生活质量的独立预测因素。
