How Does Brainstem Involvement Affect Prognosis in XXXX with Limited Brain Metastases? Results of a Matched-Cohort Analysis.

@entity1 @entity85 @entity137 @entity3
OBJECTIVE: Although brainstem @entity3 are thought to portend an inferior prognosis compared to non-brainstem brain @entity3 , there is limited evidence to support this claim, particularly in the modern radiosurgical era. METHODS: We collected the clinical data for 500 @entity1 with brain @entity3 treated at our institution with stereotactic radiosurgery (SRS). All @entity1 received SRS to at least one brain metastasis, and all brainstem @entity3 underwent SRS. After propensity score matching, clinical characteristics and overall survival were calculated and compared between groups. RESULTS: Three hundred sixteen @entity1 with brain @entity3 were analyzed after matching (143 with brainstem involvement and 173 without). @entity1 with brainstem @entity3 lived shorter after first SRS than @entity1 without brainstem @entity3 did (median 4.4 and 6.5 months, respectively; P  = 0.01), and they were more likely to have received whole brain irradiation (P  = 0.003). @entity1 with a single metastasis did not survive longer than @entity1 with multiple brain @entity3 if there was brainstem involvement (P  = 0.45). The incidence of new @entity85 and severe @entity137 after SRS did not differ between groups. CONCLUSIONS: The survival of @entity1 with brain @entity3 is inferior after a metastatic lesion develops within the brainstem, despite favorable local control with brainstem SRS. The brainstem location should be considered a negative prognostic factor for survival after SRS, and it could result from the eloquence of this location. Future research could identify the clinically life-limiting component of brainstem @entity3 .
