Figure 2 Kaplan-Meier survival curves at 2 years according to type of treatment for BMs. Table 4 Time to brain progression (TTBP) and overall survival (OS) according to the type of treatment for brain metastases   Surgery-SRS 88 pts WBRT 136 pts Chemotherapy 66 pts BPFa survival at 1 year 80 % 76 % 62 % BPF survival at 2 years 71 % 53.5 % 34 % median TTBP 27 months 25 months 14 months   (C.I. 95%:16-21) (C.I. 95%:20-30) (C.I. 95%:11-17) 1 year OS 74.9 % 47.3 % 33.6 % 2 years OS 42.1 % 23 % 11.5 % median OS 18 months 10 months 8 months

selleck kinase inhibitor   (C.I. 95%:26-28) (C.I. 95%:7-14) (C.I. 95%:7-10) aBrain Progression Free Survival Table 5 Univariate and multivariate analysis of prognostic factors for overall check details survival Overall survival Univariate Analysis Multivariate Analysis   HR (95% CI) p value HR (95% CI) p value Age (≤ 65 vs >65) 1.31 (0.93-1.87) 0.12     Sex (male vs female) 1.37 (0.99-1.91) 0.06     Primary Tumor NA 0.01 NA 0.017 Site NA 0.60     (subtentorial vs supratentorial) 0.72 (0.40-1.29) 0.28     (supratentorial and subtentorial

vs supratentorial ) 1.40 (0.96-2.05) 0.75     (supratentorial and subtentorial vs subtentorial 1.93 (1.1-2.53) 0.03     Neurologic Symptom (yes vs no) 1.51 (1.06-2.14) 0.02 0.66 (0.44-0.99) 0.046 RPA-RTOG classes NA 0.21     (2 vs 1) 1.18 (0.77-1.70) 0.43     (3 vs 1) 1.78 (0.93-3.43) 0.08     (2 vs 3) 0.66 (0.36-1.19) 0.16     Type of treatment NA < 0.0001   0.02 (CT vs WBRT) 1.05 (0.72-1.53) 0.78 1.16 (0.76-1.76) 0.47 (Surgery/SRS vs WBRT) 0.37 (0.23-0.61) < 0.0001 0.47 (0.26-0.87) 0.02 (Surgery/SRS vs CT) 0.35 (0.21-0.60) < 0.0001 0.41 (0.21-0.77) 0.006 Number of brain Phospholipase D1 metastases NA < 0.0001   0.013 (2-3 vs 1) 1.39 (0.86-2.24) 0.17 1.36 (0.79-2.34) 0.25 (>3 vs 1) 2.20

(1.48-3.27) < 0.0001 2.04 (1.26-3.33) 0.004 (2-3 vs >3) 0.63 (0.41-0.96) 0.03 0.66 (0.41-1.07) 0.10 To assess whether the availability of resources for local approach would impact on disease outcome of patients with BMs, we analyzed the up-front strategy for BMs on the basis of the treatment received at each institution with respect to the number of brain lesions (≤ 3 vs > 3). Group A included 235 patients referring to a comprehensive cancer center where resources for either local (surgery and SRS) and regional/systemic (WBRT and chemotherapy) approaches were available. Group B included 55 patients referring to 3 different institutions where only regional/systemic approaches were available (WBRT in one center, chemotherapy in all centers) (Table 1). Patients with ≤ 3 brain lesions were 58% in both cohorts (n = 137/235 for group A and n = 32/55 for group B). In subpopulation of patients with ≤ 3 BMs, local treatment was delivered in 54% of cases for group A (75 out of 137 patients) but in only 18% for group B (6 out of 32 patients). No difference was found in terms of time to brain progression at 1 year between group A and B (74.2% vs 71.6% respectively, P =.89).