OBJECTIVE The literature on non-small cell lung cancer (NSCLC) brain metastases (BMs) managed using stereotactic radiosurgery (SRS) relies mainly on single-institution studies or randomized controlled trials (RCTs). There is a literature gap on clinical and radiological outcomes of SRS for NSCLC metastases in real-world practice. The objective of this study was to benchmark mortality and progression outcomes in patients undergoing SRS for NSCLC BMs and identify risk factors for these outcomes using a national quality registry. METHODS The SRS Registry of the NeuroPoint Alliance was used for this study. This registry included patients from 16 enrolling sites who underwent SRS from 2017 to 2022. Data are prospectively collected without a prespecified research purpose. The main outcomes of this analysis were overall survival (OS), out-of-field recurrence, local progression, and intracranial progression. All time-to-event investigations included Kaplan-Meier analyses and multivariable Cox regressions. RESULTS Two hundred sixty-four patients were identified, with a mean age of 66.7 years and a female proportion of 48.5%. Most patients (84.5%) had a Karnofsky Performance Status (KPS) score of 80-100, and the mean baseline EQ-5D score was 0.539 quality-adjusted life years. A single lesion was present in 53.4% of the patients, and 29.1% of patients had 3 or more lesions. The median OS was 28.1 months, and independent predictors of mortality included no control of primary tumor (hazard ratio [HR] 2.1), KPS of 80 (HR 2.4) or lower (HR 2.4), coronary artery disease (HR 2.8), and 5 or more lesions present at the time of SRS treatment (HR 2.3). The median out-of-field progression-free survival (PFS) was 24.8 months, and the median local PFS was unreached. Intralesional hemorrhage was an independent risk factor of local progression, with an HR of 6.0. The median intracranial PFS was 14.0 months and was predicted by the number of lesions at the time of SRS (3-4 lesions, HR 2.2; 5-14 lesions, HR 2.5). CONCLUSIONS In this real-world prospective study, the authors used a national quality registry and found favorable OS in patients with NSCLC BMs undergoing SRS compared with results from previously published RCTs. The intracranial PFS was mainly driven by the emergence of new lesions rather than local progression. A greater number of lesions at baseline was associated with out-of-field progression, while intralesional hemorrhage at baseline was associated with local progression.

中文翻译：

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立体定向放射外科治疗非小细胞肺癌脑转移：一项使用 NeuroPoint 联盟立体定向放射外科登记处的前瞻性研究。

目的 关于使用立体定向放射外科 (SRS) 治疗非小细胞肺癌 (NSCLC) 脑转移 (BM) 的文献主要依赖于单机构研究或随机对照试验 (RCT)。在现实世界实践中，关于 NSCLC 转移的 SRS 临床和放射学结果存在文献空白。本研究的目的是对接受 SRS 治疗 NSCLC 脑转移的患者的死亡率和进展结果进行基准测试，并使用国家质量登记处确定这些结果的风险因素。方法 本研究使用 NeuroPoint 联盟的 SRS 注册系统。该登记包括来自 16 个招募点的 2017 年至 2022 年接受 SRS 的患者。数据是前瞻性收集的，没有预先指定的研究目的。该分析的主要结果是总生存期（OS）、场外复发、局部进展和颅内进展。所有事件发生时间调查均包括 Kaplan-Meier 分析和多变量 Cox 回归。结果 共确定 264 名患者，平均年龄 66.7 岁，女性比例为 48.5%。大多数患者 (84.5%) 的卡诺夫斯基体能状况 (KPS) 评分为 80-100，平均基线 EQ-5D 评分为 0.539 质量调整生命年。53.4%的患者存在单一病灶，29.1%的患者存在3个或更多病灶。中位 OS 为 28.1 个月，死亡率的独立预测因素包括原发肿瘤未得到控制（风险比 [HR] 2.1）、KPS 为 80 (HR 2.4) 或更低 (HR 2.4)、冠状动脉疾病 (HR 2.8) 和SRS 治疗时存在 5 个或更多病变（HR 2.3）。中位外场无进展生存期 (PFS) 为 24.8 个月，中位局部 PFS 尚未达到。病灶内出血是局部进展的独立危险因素，HR 为 6.0。中位颅内 PFS 为 14.0 个月，根据 SRS 时的病变数量预测（3-4 个病变，HR 2.2；5-14 个病变，HR 2.5）。结论 在这项现实世界的前瞻性研究中，作者使用了国家质量注册中心，发现接受 SRS 的 NSCLC 脑转移患者的 OS 与之前发表的随机对照试验的结果相比良好。颅内 PFS 主要由新病灶的出现而非局部进展驱动。基线时病灶数量较多与视野外进展相关，而基线时病灶内出血与局部进展相关。