S884
Clinical - Mixed sites & palliation
ESTRO 2026
2499 Characteristics of long-term survivors of brain metastases treated with radiation Sergi Benavente 1 , Marcelino Hermida 2 , Enrique Rodríguez-Zafra 3 , Francisco Martínez-Ricarte 4 1 Radiation Oncology, Vall d'Hebron University Hospital, Barcelona, Spain. 2 Medical Physics and Radiation Protection, Vall d'Hebron University Hospital, Barcelona, Spain. 3 Neuroradiology Section, Vall d'Hebron University Hospital, Barcelona, Spain. 4 Neurosurgery, Valld'Hebron University Hospital, Barcelona, Spain Purpose/Objective: Despite rising rates of brain metastases, progress in systemic and local treatments has achieved higher survival rates. However, little is known about the outcomes of long-term survivors. Material/Methods: Data from an institutional registry of patients with brain metastases treated with radiation were retrieved for the years 2016-2022. Clinical information on survival, disease progression, and cancer treatment for patients surviving ≥ 3 years after radiotherapy was collected. Results: During this period, 666 patients received radiation for brain metastases. Of these, 84 (12.6%) survived ≥ 3 years. The median survival time for long-term survivors (LTS) was 6.6 years. NSCLC, breast, SCLC, renal, and melanoma were the most common primary tumors among LTS, and 32 (38%) had clinically actionable tumors. Most patients presented with fewer than 10 brain metastases. In this subgroup, 47 (56%) received SRS/fSRS, 12 (14%) did not receive subsequent systemic treatments, and 37 (44%) received immunotherapy after radiation. New brain metastases occurred in 47 patients (56%), of whom 28 (60%) received an additional course of radiation. When the second course was SRS/fSRS, it occurred preferentially in the first year after the initial SRS. In contrast, if it was performed after WBRT, it occurred preferentially between years 1 and 2. In total, 51 LTS were alive at last follow-up, and in 22 of them (26%), there was no evidence of disease. Conclusion: Survival after brain metastases is rising. The long-term survivors can achieve reasonable intracranial control in a wide range of tumor settings. These findings support the importance of critically evaluating the long-term impact of treatments. Keywords: Brain metastases, radiosurgery, survivors
Purpose/Objective: Stereotactic radiotherapy (SRT) is a well-established treatment for brain metastases (BM) from solid tumors, used both as definitive therapy and as an adjuvant post-operative approach to reduce local recurrence. With the emergence of advanced systemic therapies and improved imaging enabling closer follow-up, it is essential to re-evaluate the role of SRT in this evolving landscape. this study evaluates survival outcomes, local control rates, treatment-related toxicities, and prognostic factors influencing clinical efficacy and patient selection. Material/Methods: We retrospectively analyzed data from 251 patients with BM treated with SRT between 2015 and 2022. Median follow-up was 22.8 months, and median age was 64.7 years. Primary tumors mainly included lung (40%), melanoma (20%), and breast cancer (17%). Single-fraction stereotactic radiosurgery (SRS) was administered in 44% of cases (median dose: 18 Gy), while the remainder received fractionated SRT (median dose: 27 Gy in 3 fractions). Surgical resection preceded SRT in 30% of patients; 20% received concurrent systemic therapy. Results: Median overall survival (OS) was 13.7 months, with a 1- year OS rate of 43%. One-year local failure-free survival (LFS) was 88% after SRS and 79% after fractionated SRT. Local control did not significantly influence OS. Favorable prognostic factors for LFS included KPS ≥ 80, age <65 years, and physical dose >20 Gy. Improved OS was associated with controlled primary tumor, absence of extracranial progression, and no lymph node metastasis (all p<0.05). Radiation necrosis occurred in 10% of patients, with lesion volume >5 cm ³ significantly increasing risk (HR 2.8); symptomatic cases were rare (2.4%). Leptomeningeal dissemination was observed in 5.7%, predominantly in patients who had undergone prior tumor resection (82.4%). Conclusion: SRT provides excellent local control and favorable survival with low toxicity in well-selected patients with BM. Postoperative SRT was associated with a higher rate of leptomeningeal recurrence, highlighting the need for further optimization of treatment timing and target definition. Continued evaluation in the context of evolving systemic therapy is essential to refine patient selection and improve long-term outcomes. Keywords: leptomeningeal recurrence, Radiation necrosis
Digital Poster
Mini-Oral
Made with FlippingBook - Share PDF online