Background/Aims: Brain metastases from bladder cancer are rare and published outcomes data are sparse. To date, no institutions have reported a series of patients with brain metastases from bladder cancer treated with stereotactic radiosurgery (SRS). Our aim was to identify patients with brain metastases from bladder primaries treated with SRS with or without surgical resection and report the clinical outcomes. Methods: Patients meeting eligibility criteria at our institution between 2000 and 2017 were included. The clinical variables of interest, including overall survival (OS), local recurrence, V12, distant brain failure (DBF), and initial brain metastases velocity, were calculated. Cox proportional hazards analysis was performed to identify predictors of time-to-event outcomes. Results: A total of 14 patients were included. The median OS from the time of treatment was 2.1 months. Factors predictive of OS include intracranial resection (HR 0.21, p = 0.03). The cumulative incidence of local failure was 21% at 6 months and 30% at 12 months. The cumulative incidence of DBF at 6 and 12 months was 23 and 31%, respectively. Conclusions: The prognosis in this patient population remains guarded. Factors associated with improved survival include intracranial resection. Future, prospective work is needed to further define optimal management.

1.
Mahmoud-Ahmed AS, Suh JH, Kupelian PA, et al: Brain metastases from bladder carcinoma: presentation, treatment and survival. J Urol 2002; 167: 2419–2422.
2.
Saha A, Ghosh S, Roy C, Choudhury K, Chakrabarty B, Sarkar R: Demographic and clinical profile of patients with brain metastases: a retrospective study. Asian J Neurosurg 2013; 8: 157.
3.
Rades D, Meyners T, Veninga T, Stalpers LJA, Schild SE: Hypofractionated whole-brain radiotherapy for multiple brain metastases from transitional cell carcinoma of the bladder. Int J Radiat Oncol Biol Phys 2010; 78: 404–408.
4.
Grossman HB, Natale RB, Tangen CM, et al: Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med 2003; 349: 859–866.
5.
Vale C: Neoadjuvant chemotherapy in invasive bladder cancer: a systematic review and meta-analysis. Lancet 2003; 361: 1927–1934.
6.
Aoyama H, Hiroki S, Tago M, et al: Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases. JAMA 2006; 295: 2483–2491.
7.
Shen CJ, Lim M, Kleinberg LR: Controversies in the therapy of brain metastases: shifting paradigms in an era of effective systemic therapy and longer-term survivorship. Curr Treat Options Oncol 2016; 17: 46.
8.
Andrews DW, Scott CB, Sperduto PW, et al: Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet 2004; 363: 1665–1672.
9.
Chang EL, Wefel JS, Hess KR, et al: Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol 2009; 10: 1037–1044.
10.
Kocher M, Soffietti R, Abacioglu U, et al: Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. J Clin Oncol 2011; 29: 134–141.
11.
Yamamoto M, Serizawa T, Shuto T, et al: Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study. Lancet Oncol 2014; 15: 387–395.
12.
Shaw E, Scott C, Souhami L, et al: Single dose radiosurgical treatment of recurrent previously irradiated primary brain tumors and brain metastases: final report of RTOG protocol 90-95. Int J Radiat Oncol Biol Phys 2000; 47: 291–298.
13.
Mctyre ER, Johnson AG, Ruiz J, et al: Predictors of neurologic and nonneurologic death in patients with brain metastasis initially treated with upfront stereotactic radiosurgery without whole-brain radiation therapy. Neuro Oncol 2017; 19: 558–566.
14.
Patchell RA, Tibbs PA, Regine WF, et al: Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA 1998; 280: 1485–1489.
15.
Farris M, Mctyre ER, Cramer CK, et al: Brain metastasis velocity: a novel prognostic metric predictive of overall survival and freedom from whole-brain radiation therapy after distant brain failure following upfront radiosurgery alone. Int J Radiat Oncol Biol 2017; 98: 131–141.
16.
Mehta MP, Tsao MN, Whelan TJ, et al: The American Society for Therapeutic Radiology and Oncology (ASTRO) evidence-based review of the role of radiosurgery for brain metastasis. Int J Radiat Oncol Biol Phys 2005; 63: 37–46.
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