To assess surveillance strategies and outcomes specifically for patients treated with systemic therapy alone for active brain metastases.
Key Findings:
14 out of 33 patients' treatments met the 2021 guidelines.
Median time to 1st, 2nd, and 3rd MRI was 45, 95, and 180 days, respectively.
One-year cumulative incidence of local progression was 0.43 (95% CI [0.18-0.66]) in the guideline group and 0.32 (95% CI [0.13-0.52]) in the non-guideline group (p=0.5).
One-year cumulative incidence of brain radiation was 0.29 (95% CI [0.09-0.53]) in the guideline group and 0.44 (95% CI [0.22-0.64]) in the non-guideline group (p=0.87).
Two patients experienced seizures as safety events during systemic therapy.
Interpretation:
CNS-penetrating systemic therapies are increasingly used, often exceeding guideline recommendations, indicating a need for improved surveillance imaging frequency and management of recurrences, as many patients delayed radiation for over a year with few safety events.
Limitations:
Retrospective design may limit the generalizability of findings.
Small sample size restricts statistical power and robustness of conclusions.
Lack of standardized surveillance protocols may affect consistency in monitoring.
Conclusion:
As interest in CNS-penetrating therapies grows, there is a critical need for evidence-based guidelines for patient surveillance in this evolving treatment landscape, necessitating further research.
A Keck Medicine of USC neurointerventionalist discusses how a minimally invasive, endovascularly implantable cerebrospinal fluid shunt is the next-generation treatment for normal pressure hydrocephalus — and possibly more.
