Stereotactic radiosurgery for prostate cancer cerebral metastases: an international multicenter study

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  • 1 Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia;
  • | 2 Department of Neurosurgery, School of Medicine, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan, and National Yang-Ming University, Taipei, Taiwan;
  • | 3 Department of Neurosurgery, Penn State College of Medicine, Hershey, Pennsylvania;
  • | 4 Department of Radiation and Stereotactic Neurosurgery, Na Homolce Hospital, Prague, Czech Republic;
  • | 5 Departments of Neurosurgery and
  • | 6 Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh, India;
  • | 7 Division of Neurosurgery, Université de Sherbrooke, Centre de recherché du CHUS, Sherbrooke, Quebec, Canada;
  • | 8 Department of Neurosurgery, Koc University School of Medicine, Istanbul, Turkey;
  • | 9 Departments of Radiation Oncology and
  • | 10 Neurosurgery, New York University Langone Medical Center, New York, New York;
  • | 11 Department of Neurosurgery, University of Pittsburgh, Pennsylvania; and
  • | 12 Athens University of Economics and Business, Athens, Greece
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OBJECTIVE

As novel therapies improve survival for men with prostate cancer, intracranial metastatic disease has become more common. The purpose of this multicenter study was to evaluate the safety and efficacy of stereotactic radiosurgery (SRS) in the management of intracranial prostate cancer metastases.

METHODS

Demographic data, primary tumor characteristics, SRS treatment parameters, and clinical and imaging follow-up data of patients from nine institutions treated with SRS from July 2005 to June 2020 for cerebral metastases from prostate carcinoma were collected and analyzed.

RESULTS

Forty-six patients were treated in 51 SRS procedures for 120 prostate cancer intracranial metastases. At SRS, the mean patient age was 68.04 ± 9.05 years, the mean time interval from prostate cancer diagnosis to SRS was 4.82 ± 4.89 years, and extracranial dissemination was noted in 34 (73.9%) patients. The median patient Karnofsky Performance Scale (KPS) score at SRS was 80, and neurological symptoms attributed to intracranial involvement were present prior to 39 (76%) SRS procedures. Single-fraction SRS was used in 49 procedures. Stereotactic radiotherapy using 6 Gy in five sessions was utilized in 2 procedures. The median margin dose was 18 (range 6–28) Gy, and the median tumor volume was 2.45 (range 0.04–45) ml. At a median radiological follow-up of 6 (range 0–156) months, local progression was seen with 14 lesions. The median survival following SRS was 15.18 months, and the 1-year overall intracranial progression-free survival was 44%. The KPS score at SRS was noted to be associated with improved overall (p = 0.02) and progression-free survival (p = 0.03). Age ≥ 65 years at SRS was associated with decreased overall survival (p = 0.04). There were no serious grade 3–5 toxicities noted.

CONCLUSIONS

SRS appears to be a safe, well-tolerated, and effective management option for patients with prostate cancer intracranial metastases.

ABBREVIATIONS

KPS = Karnofsky Performance Scale; OS = overall survival; SRS = stereotactic radiosurgery; WBRT = whole-brain radiation therapy.

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