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Medical AI Inquiry: You was designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.  Labels: BACKGROUND, METHODS, RESULTS. Meshes: Adult, Aged, Aged, 80 and over, Brain Neoplasms, Cohort Studies, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prognosis, Radiosurgery, Retrospective Studies, Time Factors, Treatment Outcome.
user
Are patients with long-term control of systemic disease a favorable prognostic group for treatment of brain metastases with SRS alone? Context: Stereotactic radiosurgery (SRS) alone is an attractive option for treatment of brain metastases that avoids whole brain irradiation (WBRT)-associated morbidity, but is limited by regional CNS failures and short survival in some patients. We evaluated a subgroup of patients with controlled systemic disease that may represent a favorable patient population for SRS alone. All patients with brain metastases treated with SRS without WBRT at our institution between 2004 and 2014 were grouped into two cohorts, those with controlled systemic disease for ≥1yr (CSD) prior to presentation with brain metastases and those without (USD). Rates of local and regional CNS failure, and overall survival were assessed with chi-square and Student's t tests. Cox regression analysis was performed to evaluate independent predictors of regional control and overall survival. A total of 294 patients underwent SRS to 697 lesions, of which 65 patients had CSD. Median follow-up was 9.7 mos. There was no difference in local control between the two cohorts (p=0.795). Regional CNS control was significantly better for patients with CSD, 68% vs. 48% (p=0.001). Overall survival at 1 and 5 years for CSD were 65% and 13%, with USD yielding 41% and 7% (p<0.001). Multivariate analysis demonstrated that USD (relative CSD) independently predicts regional failure (HR1.75; p=0.008) and shorter overall survival (HR1.55; p=0.007).
assistant
Patients presenting with brain metastases after ≥1 year of primary and systemic disease control represent a particularly favorable cohort, with lower regional CNS failure and prolonged survival, for an approach of SRS alone. Final Decision: yes