2023
Local Control and Survival Outcomes After Stereotactic Radiosurgery for Brain Metastases From Gastrointestinal Primaries: An International Multicenter Analysis
Singh R, Bowden G, Mathieu D, Perlow H, Palmer J, Elhamdani S, Shepard M, Liang Y, Nabeel A, Reda W, Tawadros S, Abdelkarim K, El-Shehaby A, Emad R, Elazzazi A, Warnick R, Gozal Y, Daly M, McShane B, Addis-Jackson M, Karthikeyan G, Smith S, Picozzi P, Franzini A, Kaisman-Elbaz T, Yang H, Wei Z, Legarreta A, Hess J, Templeton K, Pikis S, Mantziaris G, Simonova G, Liscak R, Peker S, Samanci Y, Chiang V, Niranjan A, Kersh C, Lee C, Trifiletti D, Lunsford L, Sheehan J. Local Control and Survival Outcomes After Stereotactic Radiosurgery for Brain Metastases From Gastrointestinal Primaries: An International Multicenter Analysis. Neurosurgery 2023, 93: 592-598. PMID: 36942965, DOI: 10.1227/neu.0000000000002456.Peer-Reviewed Original ResearchConceptsKarnofsky performance statusStereotactic radiosurgeryOverall survivalBrain metastasesUnivariate analysisLocal controlGI primaryExtracranial metastasesPrognostic factorsBrain metastases treated with stereotactic radiosurgeryAssociated with inferior LCAssociated with inferior OSMedian Karnofsky performance statusEvaluate potential prognostic factorsInternational multicenter analysisPlanning target volumePotential prognostic factorsKaplan-Meier analysisOne-yearProportional hazards modelInferior LCInferior OSOS ratesLC ratesGastrointestinal primaryTransfrontal Approach to the Amygdala for Ablation With Laser Interstitial Thermal Therapy: An Epilepsy Case Report
Lamsam L, Brigido M, Sivaraju A, Hirsch L, Spencer D, Chiang V, Damisah E. Transfrontal Approach to the Amygdala for Ablation With Laser Interstitial Thermal Therapy: An Epilepsy Case Report. Operative Neurosurgery 2023, 24: e381-e384. PMID: 36715982, PMCID: PMC10158899, DOI: 10.1227/ons.0000000000000576.Peer-Reviewed Original ResearchConceptsStereotactic laser amygdalohippocampotomyLaser interstitial thermal therapyEntorhinal cortexInterstitial thermal therapyComplete ablationMesial temporal lobe epilepsyTemporal arteriovenous malformationTemporal lobe epilepsyLeft temporal arteriovenous malformationMiddle frontal gyrusPrior craniotomyOpen resectionLobe epilepsyCase reportMedial amygdalaArteriovenous malformationsAnterior entorhinal cortexTransfrontal approachAmygdalaInvasive surgeryFrontal gyrusThermal therapyIntracranial electroencephalographyResection
2021
Outcomes of Stereotactic Radiosurgery and Immunotherapy in Renal Cell Carcinoma Patients With Brain Metastases
Uezono H, Nam D, Kluger HM, Sznol M, Hurwitz M, Yu JB, Chiang VL. Outcomes of Stereotactic Radiosurgery and Immunotherapy in Renal Cell Carcinoma Patients With Brain Metastases. American Journal Of Clinical Oncology 2021, 44: 495-501. PMID: 34432667, DOI: 10.1097/coc.0000000000000849.Peer-Reviewed Original ResearchConceptsImmune checkpoint inhibitorsRCC brain metastasesBrain metastasesRenal cell carcinomaStereotactic radiosurgeryOverall survivalUse of ICIsCentral nervous system toxicityRenal cell carcinoma patientsImpact of immunotherapyLocal control outcomesMedian overall survivalCell carcinoma patientsKaplan-Meier curvesNervous system toxicityBetter median OSLog-rank testMann-Whitney U testMargin doseMedian OSNonimmunotherapy groupSRS doseCheckpoint inhibitorsImmunotherapy groupCarcinoma patientsComparison of radiomic feature aggregation methods for patients with multiple tumors
Chang E, Joel MZ, Chang HY, Du J, Khanna O, Omuro A, Chiang V, Aneja S. Comparison of radiomic feature aggregation methods for patients with multiple tumors. Scientific Reports 2021, 11: 9758. PMID: 33963236, PMCID: PMC8105371, DOI: 10.1038/s41598-021-89114-6.Peer-Reviewed Original ResearchConceptsCox proportional hazards modelCox proportional hazardsProportional hazards modelBrain metastasesRadiomic featuresHazards modelProportional hazardsStandard Cox proportional hazards modelMultifocal brain metastasesMultiple brain metastasesNumber of patientsPatient-level outcomesHigher concordance indexRadiomic feature analysisRandom survival forest modelSurvival modelsDifferent tumor volumesMultifocal tumorsCancer outcomesMultiple tumorsMetastatic cancerConcordance indexTumor volumePatientsTumor typesTumor DNA Mutations From Intraparenchymal Brain Metastases Are Detectable in CSF
Cheok SK, Narayan A, Arnal-Estape A, Gettinger S, Goldberg SB, Kluger HM, Nguyen D, Patel A, Chiang V. Tumor DNA Mutations From Intraparenchymal Brain Metastases Are Detectable in CSF. JCO Precision Oncology 2021, 5: 163-172. PMID: 34250381, PMCID: PMC8232069, DOI: 10.1200/po.20.00292.Peer-Reviewed Original ResearchConceptsIntraparenchymal brain metastasesBrain metastasesCell-free DNAExtracranial tumorsBrain metastasis tissuesProgressive brain metastasesThird of patientsNormal pressure hydrocephalusTumor DNA mutationsPrimary cancer typeAnalysis of CSFSamples of CSFLeptomeningeal diseaseEffective surrogate markerBrain biopsyPressure hydrocephalusLumbar punctureSurrogate markerCancer-associated genesMetastasis tissuesPatientsMetastasisDiscordant responsesRenal cellsGenomic profiling
2020
Survival in Patients With Brain Metastases: Summary Report on the Updated Diagnosis-Specific Graded Prognostic Assessment and Definition of the Eligibility Quotient.
Sperduto PW, Mesko S, Li J, Cagney D, Aizer A, Lin NU, Nesbit E, Kruser TJ, Chan J, Braunstein S, Lee J, Kirkpatrick JP, Breen W, Brown PD, Shi D, Shih HA, Soliman H, Sahgal A, Shanley R, Sperduto WA, Lou E, Everett A, Boggs DH, Masucci L, Roberge D, Remick J, Plichta K, Buatti JM, Jain S, Gaspar LE, Wu CC, Wang TJC, Bryant J, Chuong M, An Y, Chiang V, Nakano T, Aoyama H, Mehta MP. Survival in Patients With Brain Metastases: Summary Report on the Updated Diagnosis-Specific Graded Prognostic Assessment and Definition of the Eligibility Quotient. Journal Of Clinical Oncology 2020, 38: 3773-3784. PMID: 32931399, PMCID: PMC7655019, DOI: 10.1200/jco.20.01255.Peer-Reviewed Original ResearchConceptsGraded Prognostic AssessmentDiagnosis-Specific Graded Prognostic AssessmentBrain metastasesPrognostic factorsClinical trialsPrognostic assessmentLarge contemporary cohortSignificant prognostic factorsEnrollment of patientsNew prognostic factorsMulti-institutional databaseMedian survivalMultivariable analysisContemporary cohortWorse prognosisCell lungIndividualize treatmentTreatment choicePoor survivalRenal cancerPatientsPromising treatmentExpansion of eligibilityMetastasisPrimary siteEvaluation of First-line Radiosurgery vs Whole-Brain Radiotherapy for Small Cell Lung Cancer Brain Metastases
Rusthoven CG, Yamamoto M, Bernhardt D, Smith DE, Gao D, Serizawa T, Yomo S, Aiyama H, Higuchi Y, Shuto T, Akabane A, Sato Y, Niranjan A, Faramand AM, Lunsford LD, McInerney J, Tuanquin LC, Zacharia BE, Chiang V, Singh C, Yu JB, Braunstein S, Mathieu D, Touchette CJ, Lee CC, Yang HC, Aizer AA, Cagney DN, Chan MD, Kondziolka D, Bernstein K, Silverman JS, Grills IS, Siddiqui ZA, Yuan JC, Sheehan JP, Cordeiro D, Nosaki K, Seto T, Deibert CP, Verma V, Day S, Halasz LM, Warnick RE, Trifiletti DM, Palmer JD, Attia A, Li B, Cifarelli CP, Brown PD, Vargo JA, Combs SE, Kessel KA, Rieken S, Patel S, Guckenberger M, Andratschke N, Kavanagh BD, Robin TP. Evaluation of First-line Radiosurgery vs Whole-Brain Radiotherapy for Small Cell Lung Cancer Brain Metastases. JAMA Oncology 2020, 6: 1028-1037. PMID: 32496550, PMCID: PMC7273318, DOI: 10.1001/jamaoncol.2020.1271.Peer-Reviewed Original ResearchConceptsWhole brain radiotherapyProgression-free survivalSmall-cell lung cancer (SCLC) brain metastasesCell lung cancer brain metastasesCNS progression-free survivalLung cancer brain metastasesPropensity score-matched analysisMedian overall survivalCancer brain metastasesBrain metastasesOverall survivalStereotactic radiosurgeryCentral nervous system (CNS) progression-free survivalMedian CNS progression-free survivalSRS outcomesCentral nervous system progressionSmall cell lung cancerLimited brain metastasesMulticenter cohort studyDisease control statusCell lung cancerSingle-arm trialStandard of careLeptomeningeal progressionWBRT cohortLaser interstitial thermal therapy (LITT) vs. bevacizumab for radiation necrosis in previously irradiated brain metastases
Sujijantarat N, Hong CS, Owusu KA, Elsamadicy AA, Antonios JP, Koo AB, Baehring JM, Chiang VL. Laser interstitial thermal therapy (LITT) vs. bevacizumab for radiation necrosis in previously irradiated brain metastases. Journal Of Neuro-Oncology 2020, 148: 641-649. PMID: 32602021, DOI: 10.1007/s11060-020-03570-0.Peer-Reviewed Original ResearchConceptsLaser interstitial thermal therapyLonger overall survivalRadiation necrosisInterstitial thermal therapyBrain metastasesOverall survivalMedian volume decreaseMedian volume increaseBrain metastasis patientsPre-treatment patient characteristicsRetrospective chart reviewResultsTwenty-five patientsPre-treatment factorsBevacizumab patientsChart reviewMetastasis patientsLocal recurrencePatient characteristicsTreatment optionsTreatment responseBevacizumabPatientsLesional volumeThermal therapyStatistical significanceLaser Ablation of Abnormal Neurological Tissue Using Robotic NeuroBlate System (LAANTERN): 12-Month Outcomes and Quality of Life After Brain Tumor Ablation
Kim AH, Tatter S, Rao G, Prabhu S, Chen C, Fecci P, Chiang V, Smith K, Williams BJ, Mohammadi AM, Judy K, Sloan A, Tovar-Spinoza Z, Baumgartner J, Hadjipanayis C, Leuthardt EC. Laser Ablation of Abnormal Neurological Tissue Using Robotic NeuroBlate System (LAANTERN): 12-Month Outcomes and Quality of Life After Brain Tumor Ablation. Neurosurgery 2020, 87: e338-e346. PMID: 32315434, PMCID: PMC7534487, DOI: 10.1093/neuros/nyaa071.Peer-Reviewed Original ResearchConceptsKarnofsky performance scorePrimary tumorBaseline Karnofsky performance scoreCancer Therapy-BrainPostprocedure hospital stayReal-world registryPatient-reported QOLNeurological tissuesHigh-grade gliomasQuality of lifeReal-world outcomesBaseline comorbiditiesHospital stayAdverse eventsMost patientsOverall survivalMedian ageBrain tumor ablationRadiation necrosisPatient populationMetastatic cancerFunctional assessmentSurvival rateBaseline levelsQoLPembrolizumab for management of patients with NSCLC and brain metastases: long-term results and biomarker analysis from a non-randomised, open-label, phase 2 trial
Goldberg SB, Schalper KA, Gettinger SN, Mahajan A, Herbst RS, Chiang AC, Lilenbaum R, Wilson FH, Omay SB, Yu JB, Jilaveanu L, Tran T, Pavlik K, Rowen E, Gerrish H, Komlo A, Gupta R, Wyatt H, Ribeiro M, Kluger Y, Zhou G, Wei W, Chiang VL, Kluger HM. Pembrolizumab for management of patients with NSCLC and brain metastases: long-term results and biomarker analysis from a non-randomised, open-label, phase 2 trial. The Lancet Oncology 2020, 21: 655-663. PMID: 32251621, PMCID: PMC7380514, DOI: 10.1016/s1470-2045(20)30111-x.Peer-Reviewed Original ResearchConceptsBrain metastasis responseYale Cancer CenterPD-L1 expressionPhase 2 trialUntreated brain metastasesBrain metastasesAdrenal insufficiencyAdverse eventsMetastasis responseCNS diseaseCancer CenterCohort 2Cohort 1Eastern Cooperative Oncology Group performance statusTreatment-related serious adverse eventsModified Response Evaluation CriteriaStage IV NSCLCTreatment-related deathsAcute kidney injuryPD-1 blockadeSerious adverse eventsSolid Tumors criteriaPhase 2 studyProportion of patientsResponse Evaluation CriteriaBeyond an Updated Graded Prognostic Assessment (Breast GPA): A Prognostic Index and Trends in Treatment and Survival in Breast Cancer Brain Metastases From 1985 to Today
Sperduto PW, Mesko S, Li J, Cagney D, Aizer A, Lin NU, Nesbit E, Kruser TJ, Chan J, Braunstein S, Lee J, Kirkpatrick JP, Breen W, Brown PD, Shi D, Shih HA, Soliman H, Sahgal A, Shanley R, Sperduto W, Lou E, Everett A, Boggs DH, Masucci L, Roberge D, Remick J, Plichta K, Buatti JM, Jain S, Gaspar LE, Wu CC, Wang TJC, Bryant J, Chuong M, Yu J, Chiang V, Nakano T, Aoyama H, Mehta MP. Beyond an Updated Graded Prognostic Assessment (Breast GPA): A Prognostic Index and Trends in Treatment and Survival in Breast Cancer Brain Metastases From 1985 to Today. International Journal Of Radiation Oncology • Biology • Physics 2020, 107: 334-343. PMID: 32084525, PMCID: PMC7276246, DOI: 10.1016/j.ijrobp.2020.01.051.Peer-Reviewed Original ResearchConceptsDiagnosis-specific prognostic factorsHuman epidermal receptor 2Prognostic factorsMedian survivalBreast-GPABrain metastasesBreast cancerCohort BCohort APrognostic indexReceptor 2Tumor subtypesBreast cancer brain metastasesKaplan-Meier survival estimatesCancer brain metastasesGraded Prognostic AssessmentKarnofsky performance statusLarge contemporary cohortLog-rank testFuture clinical trialsNew prognostic factorsGPA 0Extracranial metastasesPerformance statusBetter prognosis
2019
Prognosticating brain tumor patient survival after laser thermotherapy: Comparison between neuroradiological reading and semi-quantitative analysis of MRI data
Hanna JM, Temares D, Hyder F, Rothman DL, Fulbright RK, Chiang VL, Coman D. Prognosticating brain tumor patient survival after laser thermotherapy: Comparison between neuroradiological reading and semi-quantitative analysis of MRI data. Magnetic Resonance Imaging 2019, 65: 45-54. PMID: 31675529, DOI: 10.1016/j.mri.2019.09.011.Peer-Reviewed Original ResearchRole of Gamma Knife Radiosurgery in Small Cell Lung Cancer: A Multi-Institutional Retrospective Study of the International Radiosurgery Research Foundation (IRRF)
Cifarelli CP, Vargo JA, Fang W, Liscak R, Guseynova K, Warnick RE, Lee CC, Yang HC, Borghei-Razavi H, Maiti T, Siddiqui ZA, Yuan JC, Grills IS, Mathieu D, Touchette CJ, Cordeiro D, Chiang V, Hess J, Tien CJ, Faramand A, Kano H, Barnett GH, Sheehan JP, Lunsford LD. Role of Gamma Knife Radiosurgery in Small Cell Lung Cancer: A Multi-Institutional Retrospective Study of the International Radiosurgery Research Foundation (IRRF). Neurosurgery 2019, 87: 664-671. PMID: 31599324, PMCID: PMC7780439, DOI: 10.1093/neuros/nyz428.Peer-Reviewed Original ResearchConceptsSmall cell lung cancerWhole-brain irradiationSCLC brain metastasesInternational Radiosurgery Research FoundationDistant brain failureBrain metastasesOverall survivalStereotactic radiosurgerySCLC patientsBrain failureLung cancerPrior whole-brain irradiationMulti-institutional retrospective reviewKaplan-Meier survival analysisCox proportional hazards modelLocal failureProphylactic cranial irradiationInstitutional retrospective studyMedian marginal doseOngoing prospective trialsCell lung cancerGamma knife radiosurgeryInstitutional review boardValue of radiosurgeryBinary logistic regressionA Proposed Grading Scale for Predicting Outcomes After Stereotactic Radiosurgery for Dural Arteriovenous Fistulas
Mohammed N, Hung YC, Chen CJ, Xu Z, Schlesinger D, Kano H, Chiang V, Hess J, Lee J, Mathieu D, Kaufmann AM, Grills IS, Cifarelli CP, Vargo JA, Chytka T, Janouskova L, Feliciano CE, Mercado RR, Lunsford LD, Sheehan JP. A Proposed Grading Scale for Predicting Outcomes After Stereotactic Radiosurgery for Dural Arteriovenous Fistulas. Neurosurgery 2019, 87: 247-255. PMID: 31584074, PMCID: PMC7528658, DOI: 10.1093/neuros/nyz401.Peer-Reviewed Original ResearchConceptsDural arteriovenous fistulaCranial dural arteriovenous fistulasCortical venous refluxFavorable outcomeStereotactic radiosurgeryGrading systemIntracerebral hemorrhageArteriovenous fistulaScoring systemGrading scaleKaplan-Meier analysisPrior intracerebral hemorrhageClass II patientsLogistic regression analysisPractical grading systemDAVF obliterationVenous refluxII patientsClinical parametersSinus locationPredicting OutcomeSystematic reviewClass IIIPatientsROC analysisMulti-institutional validation of brain metastasis velocity, a recently defined predictor of outcomes following stereotactic radiosurgery
McTyre ER, Soike MH, Farris M, Ayala-Peacock DN, Hepel JT, Page BR, Shen C, Kleinberg L, Contessa JN, Corso C, Chiang V, Henson-Masters A, Cramer CK, Ruiz J, Pasche B, Watabe K, D'Agostino R, Su J, Laxton AW, Tatter SB, Fiveash JB, Ahluwalia M, Kotecha R, Chao ST, Braunstein SE, Attia A, Chung C, Chan MD. Multi-institutional validation of brain metastasis velocity, a recently defined predictor of outcomes following stereotactic radiosurgery. Radiotherapy And Oncology 2019, 142: 168-174. PMID: 31526671, DOI: 10.1016/j.radonc.2019.08.011.Peer-Reviewed Original ResearchConceptsBrain metastasis velocityDistant brain failureMedian overall survivalOverall survivalBrain metastasesPredictors of OSInitial brain metastasesNew brain metastasesWhole brain radiationKaplan-Meier methodHigh-risk groupPredictors of outcomeProportional hazards methodsMulti-institutional settingMulti-institutional validationMultivariate regression modelingInitial SRSBrain radiationSalvage modalityInitial treatmentBrain failureRecurrence rateValidation cohortBMV groupMelanoma histologyBrain Metastasis From Renal-Cell Carcinoma: An Institutional Study
Suarez-Sarmiento A, Nguyen KA, Syed JS, Nolte A, Ghabili K, Cheng M, Liu S, Chiang V, Kluger H, Hurwitz M, Shuch B. Brain Metastasis From Renal-Cell Carcinoma: An Institutional Study. Clinical Genitourinary Cancer 2019, 17: e1163-e1170. PMID: 31519468, DOI: 10.1016/j.clgc.2019.08.006.Peer-Reviewed Original ResearchConceptsRCC brain metastasesRecurrence-free survivalRenal cell carcinomaBrain metastasesOverall survivalClinical trialsAdvanced renal cell carcinomaCentral nervous system treatmentClear cell renal cell carcinomaMedian overall survivalSingle institution experienceGood local controlKaplan-Meier methodAggressive therapyCNS recurrenceTreatment eraCumulative incidenceExtracranial metastasesMetastatic diseaseSystemic therapyInitial presentationLocal therapyClinical symptomsRCC patientsCell carcinomaInitial SRS for Patients With 5 to 15 Brain Metastases: Results of a Multi-Institutional Experience
Hughes RT, Masters AH, McTyre ER, Farris MK, Chung C, Page BR, Kleinberg LR, Hepel J, Contessa JN, Chiang V, Ruiz J, Watabe K, Su J, Fiveash JB, Braunstein S, Chao S, Attia A, Ayala-Peacock DN, Chan MD. Initial SRS for Patients With 5 to 15 Brain Metastases: Results of a Multi-Institutional Experience. International Journal Of Radiation Oncology • Biology • Physics 2019, 104: 1091-1098. PMID: 30959122, DOI: 10.1016/j.ijrobp.2019.03.052.Peer-Reviewed Original ResearchConceptsDistant brain failureInitial stereotactic radiosurgerySalvage whole brain radiation therapyWhole-brain radiation therapySalvage stereotactic radiosurgeryBrain metastasesBrain radiation therapyOverall survivalStereotactic radiosurgeryBM groupCumulative incidenceRadiation therapyNumber of BMTwo-year cumulative incidenceMultivariable Cox proportional hazardsBrain metastasis velocityMedian overall survivalOutcomes of patientsKaplan-Meier methodLog-rank testMulti-institutional experienceRisk regression modelingCox proportional hazardsMultivariable analysisNew metastasesSurvival and prognostic factors in patients with gastrointestinal cancers and brain metastases: have we made progress?
Sperduto PW, Fang P, Li J, Breen W, Brown PD, Cagney D, Aizer A, Yu J, Chiang V, Jain S, Gaspar LE, Myrehaug S, Sahgal A, Braunstein S, Sneed P, Cameron B, Attia A, Molitoris J, Wu CC, Wang TJC, Lockney N, Beal K, Parkhurst J, Buatti JM, Shanley R, Lou E, Tandberg DD, Kirkpatrick JP, Shi D, Shih HA, Chuong M, Saito H, Aoyama H, Masucci L, Roberge D, Mehta MP. Survival and prognostic factors in patients with gastrointestinal cancers and brain metastases: have we made progress? Translational Research 2019, 208: 63-72. PMID: 30885538, PMCID: PMC6527460, DOI: 10.1016/j.trsl.2019.02.011.Peer-Reviewed Original ResearchConceptsGI cancer patientsBrain metastasesGraded Prognostic AssessmentCancer patientsPrognostic factorsNew brain metastasesLarge contemporary cohortPrognosis of patientsLog-rank testMedian survival estimatesContemporary cohortPrognostic indexClinical parametersGastrointestinal cancerPrimary diagnosisPrognostic assessmentRetrospective IRBPatientsFirst treatmentDemographic dataSurvival estimatesCurrent cohortCohortTreatmentPrognosisLocal tumor response and survival outcomes after combined stereotactic radiosurgery and immunotherapy in non-small cell lung cancer with brain metastases.
Singh C, Qian JM, Yu JB, Chiang VL. Local tumor response and survival outcomes after combined stereotactic radiosurgery and immunotherapy in non-small cell lung cancer with brain metastases. Journal Of Neurosurgery 2019, 132: 512-517. PMID: 30771783, DOI: 10.3171/2018.10.jns181371.Peer-Reviewed Original ResearchConceptsAnti-PD-1 therapyKarnofsky performance statusBrain metastasesLung cancer patientsStereotactic radiosurgeryCT groupIT groupCancer patientsNon-small cell lung cancer patientsNon-small cell lung cancerCell lung cancer patientsAntibody-positive patientsGraded Prognostic AssessmentCox regression analysisCell lung cancerMedian survival timeLocal tumor responseWhole study groupMann-Whitney U testTerms of survivalLesional responseMedian survivalPerformance statusWorse survivalComplete response
2018
Quality of life outcomes for brain metastasis patients treated with stereotactic radiosurgery: pre-procedural predictive factors from a prospective national registry.
Sheehan JP, Grills I, Chiang VL, Dong H, Berg A, Warnick RE, Kondziolka D, Kavanagh B. Quality of life outcomes for brain metastasis patients treated with stereotactic radiosurgery: pre-procedural predictive factors from a prospective national registry. Journal Of Neurosurgery 2018, 131: 1848-1854. PMID: 30579284, DOI: 10.3171/2018.8.jns181599.Peer-Reviewed Original ResearchConceptsQuality of lifeBrain metastasis patientsBrain metastasesStereotactic radiosurgeryMetastasis patientsEarly stereotactic radiosurgeryPre-procedural factorsProspective national registryPain/discomfortKarnofsky Performance Scale statusAnxiety/depressionMultivariate linear regression modelRadiological responseInitial presentationPatients' qualityMale sexPredictive factorsNational registryTreatment attributesMedical treatmentPatientsMetastasisSubscoresLife outcomesLife factors