Single fraction stereotactic radiosurgery and fractionated stereotactic radiotherapy provide equal prognosis with overall survival in patients with brain metastases at diagnosis without surgery at primary site

Sep 24, 2026

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Stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (SRT) are both established options for brain metastases, yet comparative effectiveness and safety remain unclear across cancer types. This study evaluates associations between SRS versus SRT and overall survival in patients diagnosed with brain metastases without surgery at the primary site using the National Cancer Database. Analyses applied Cox proportional hazards models adjusting for variables linked to improved survival. Results showed no statistically significant difference in survival association between SRS and SRT, supporting comparable overall prognosis and prompting further work on neurotoxicity risk differences.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages15

Reading Time38 min

AccessFree to download

Abstract

Background and purpose

Materials and methods

Results

Conclusions

Background

Incidence and prognostic impact

Current treatment options and decision factors

Submitted 8 December 2022 Accepted 14 April 2023 Published 19 May 2023 Corresponding author Chi Lin, [clin@unmc.edu](clin@unmc.edu) Academic editor Abhishek Tyagi Additional Information and Declarations can be found on page 12 DOI 10.7717/peerj.15357 Copyright 2023 Ostdiek-Wille et al. Distributed under Creative Commons CC-BY 4.0 OPEN ACCESS Single fraction stereotactic radiosurgery and fractionated stereotactic radiotherapy provide equal prognosis with overall survival in patients with brain metastases at diagnosis without surgery at primary site Garett Paul Ostdiek-Wille1 ,* , Saber Amin2 ,* , Shuo Wang2 , Chi Zhang2 and Chi Lin2 1 College of Medicine, University of Nebraska Medical Center, Omaha, NE, United States of America 2 Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, United States of America * These authors contributed equally to this work. ABSTRACT Background and purpose. Stereotactic radiosurgery (SRS) and fractionated stereotactic radiation therapy (SRT) are both treatments shown to be effective in treating brain metastases (BMs) . However, it is unknown how these treatments compare in effectiveness and safety in cancer patients with BMs regardless of the primary cancer. The main objective of this study is to investigate the SRS and SRT treatments'associations with the overall survival (OS) of patients diagnosed with BMs using the National Cancer Database (NCDB) . Materials and methods. Patients in the NCDB with breast cancer, non-small cell lung cancer, small cell lung cancer, other lung cancers, melanoma, colorectal cancer, or kidney cancer who had BMs at the time of their primary cancer diagnosis and received either SRS or SRT as treatment for their BMs were included in the study. We analyzed OS with a Cox proportional hazard analysis that adjusted variables associated with improved OS during univariable analysis. Results. Of the total 6,961 patients that fit the criteria for the study, 5,423 (77.9%) received SRS and 1,538 (22 . 1%) received SRT. Patients who received SRS treatment had a median survival time of 10.9 (95% CI [10.5􀀕11.3]), and those who received SRT treatment had a median survival time of 11 .3 (95% CI [10 .4􀀕12 .3]) months. This difference was not found to be significant (Log-rank P D 0:31) . Multivariable Cox proportional hazard analysis did not yield a significant difference between the treatments' associations with OS (Hazard Ratio: 0 .942, CI 95%[0 .882􀀕1 .006]; P D :08) or SRS vs. SRT. Conclusions. In this analysis, SRS and SRT did not show a significant difference in their associations with OS. Future studies investigating the neurotoxicity risks of SRSas compared to SRT are warranted. Subjects Neurology, Oncology, Radiology and Medical Imaging, Surgery and Surgical Specialties, Translational Medicine How to cite this article Ostdiek-Wille GP, Amin S, Wang S, Zhang C, Lin C. 2023. Single fraction stereotactic radiosurgery and fractionated stereotactic radiotherapy provide equal prognosis with overall survival in patients with brain metastases at diagnosis without surgery at primary site. PeerJ 11:e15357 [http://doi.org/10.7717/peerj.15357](http://doi.org/10.7717/peerj.15357) Keywords Stereotactic radiosurgery, Fractionated stereotactic radiotherapy, Brain metastases, Brain radiation therapy, National cancer database BACKGROUND Most malignant tumors within the brain are metastases from primary cancer elsewhere in the body (Gaspar et al., 1997) . It has been estimated that 8.5% to 9.6% of all cancer patients develop brain metastases (BMs), but the actual occurrence rate is likely higher according to autopsy studies (Sacks & Rahman, 2020) and varies based on the type of primary tumor. This is evident in the findings that BM development occurs in 40% to 50% of lung cancer patients, 5% to 15% of breast cancer patients, around 10% of melanoma patients, 0.6% to 3.2% ofCRC patients, and between 4% and 17% of advanced renal ca

FAQs

What question does the study address about SRS versus SRT?

It investigates how stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (SRT) compare in their associations with overall survival and safety for patients with brain metastases diagnosed without surgery at the primary site.

Who was included in the analysis?

Patients in the National Cancer Database with specified primary cancers who had brain metastases at the time of diagnosis and received either SRS or SRT as treatment for those metastases.

Did SRS and SRT differ in overall survival association?

No. The multivariable Cox proportional hazards analysis did not show a significant difference between treatments’ associations with overall survival.

Sep 24, 2026

Uploaded by Rowan