Treatment of brain metastases from gastrointestinal primaries: Comparing whole-brain radiotherapy and stereotactic radiosurgery in terms of survival

OBJECTIVE: The objective of the study was to analyze the clinical features and prognostic factors for survival in patients with brain metastasis (BM) from gastrointestinal primaries treated with whole-brain radiotherapy (WBRT) or stereotactic radiosurgery (SRS). METHODS: We retrospectively investigated patients with BMs resulting from gastrointestinal primaries who underwent WBRT or SRS. The effects of treatment modalities on overall survival (OS) were calculated by the Kaplan-Meier method. RESULTS: WBRT and SRS were applied to 24 and 17 patients, respectively. In the WBRT group, radiotherapy was delivered at 20-30 Gy in 5-10 fractions (fx). In the SRS group, a median dose of 22 Gy (range: 18-27 Gy) was applied in 1-3 fx. At BM diagnosis, all patients had synchronous extracranial metastases which were mostly detected in the lung and liver. Median OS values were 9 months and 4 months in the SRS and WBRT groups, respectively (p=0.005). Karnofsky performance status (KPS) score (>= 70 vs. <70), diagnosis-specific graded prognostic index, gastrointestinal (GI) graded prognostic index, cumu-lative intracranial tumor volume (CITV), controlled systemic disease, and treatment modality (WBRT vs. SBRT) were found to be related with OS. CONCLUSION: In patients with GI cancer-related BMs, SRS should be preferred in those with longer OS expectancy who have controlled extracranial disease, good KPS and CITV values of <10 cm(3).