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Lapadula L, Piombino M, Bianculli A, Caivano R, Capobianco A, Cacciatore A, Cozzolino M, Oliviero C, D'andrea B, Mileo A, Leone A, Carbone F, Fochi NP, Landriscina M, Colamaria A, Giordano G. Third whole-brain radiation therapy for multiple brain metastases. Should it be considered in selected patients? Cancer Radiother 2023; 27:725-730. [PMID: 37777371 DOI: 10.1016/j.canrad.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/25/2023] [Accepted: 05/08/2023] [Indexed: 10/02/2023]
Abstract
Whole brain reirradiation for the treatment of multiple brain metastases has shown promising results. However, concerns remain over the possible neurotoxic effects of the cumulative dose as well as the questionable radiosensitivity of recurrent metastases. A second reirradiation of the whole brain is ordinarily performed in our department for palliative purposes in patients presenting with multiple metastatic brain progression. For this study, an investigational third whole brain reirradiation has been administered to highly selected patients to obtain disease control and delay progression. Clinical outcomes and neurological toxicity were also evaluated.
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Affiliation(s)
- L Lapadula
- Radiation Oncology Department, IRCCS-CROB, Rionero in Vulture, Italy
| | - M Piombino
- Radiation Oncology Department AUOC, Policlinico Bari, Italy
| | - A Bianculli
- Radiation Oncology Department, IRCCS-CROB, Rionero in Vulture, Italy
| | - R Caivano
- Radiation Oncology Department, IRCCS-CROB, Rionero in Vulture, Italy
| | - A Capobianco
- Multidisciplinary Oncology, Health Directorate Department, IRCCS Referral Cancer Center of Basilicata (CROB), Rionero in Vulture, Italy
| | - A Cacciatore
- Radiation Oncology Department, IRCCS-CROB, Rionero in Vulture, Italy
| | - M Cozzolino
- Radiation Oncology Department, IRCCS-CROB, Rionero in Vulture, Italy
| | - C Oliviero
- Radiation Oncology Department, IRCCS-CROB, Rionero in Vulture, Italy
| | - B D'andrea
- Radiation Oncology Department, IRCCS-CROB, Rionero in Vulture, Italy
| | - A Mileo
- Oncology Unit, IRCCS Referral Cancer Center of Basilicata (CROB), Rionero in Vulture, Italy
| | - A Leone
- Department of Neurosurgery, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany; Faculty of Human Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - F Carbone
- Department of Neurosurgery, Städtisches Klinikum Karlsruhe, Karlsruhe, Germany; Division of Neurosurgery, "Riuniti" Hospital, University of Foggia, FG 71121 Foggia, Italy
| | - N P Fochi
- Division of Neurosurgery, "Riuniti" Hospital, University of Foggia, FG 71121 Foggia, Italy.
| | - M Landriscina
- Unit of Medical Oncology, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - A Colamaria
- Division of Neurosurgery, Policlinico "Riuniti", Foggia, Italy
| | - G Giordano
- Unit of Medical Oncology, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
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2
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Otto-Vollaard L, Quint S, de Pree IMN, Steinvoort IN, Tims OJL, Nuyttens JJ. Brain Metastases: Patient-Reported Outcome and Quality of Life After Whole-Brain Radiotherapy. J Palliat Med 2022; 25:1533-1539. [PMID: 35482284 DOI: 10.1089/jpm.2021.0533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The aim of this prospective cohort study was to determine the outcome and quality of life (QoL) for patients with brain metastases treated with whole-brain radiotherapy (WBRT). Materials and Methods: WBRT was given to 162 patients. Treatment outcome was reported through telephone consultation at four and eight weeks after the last fraction of the treatment. Treatment outcome was scored as a benefit when patients reported positively on the question whether radiotherapy of the whole brain did relieve their complaints. Patients who scored the treatment as beneficial were categorized as responders. The European Organization for Research and Treatment of Cancer (EORTC) questionnaire QLQ-C15-PAL was scored at day 0 and eight weeks after the last fraction of WBRT. Results: Patients who were alive after 2 months and reported benefit from treatment had a median survival of 8.1 months compared with 2.9 months for patients who reported no benefit. Forty-three patients died within two months (27%). Median overall survival was 3.5 months. Improvement of neurological symptoms was the most commonly reported benefit of the treatment. The responders had significantly better sleep (p = 0.032) and were less tense (p = 0.014). The nonresponders were also less tense (p = 0.042), but had less appetite (p = 0.023), felt weaker (p = 0.011), and experienced more fatigue (p = 0.001). Conclusions: WBRT is effective in a selected group of patients. Forty-nine percent of the patients surviving two months reported benefit from the treatment, resulting in a significantly increased survival rate for this group. However, 27% of patients died within two months. QoL increased in responders, but decreased in nonresponders.
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Affiliation(s)
| | - Sandra Quint
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Ilse M N de Pree
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Illona N Steinvoort
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Olijn J L Tims
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Joost J Nuyttens
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
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Nieder C, Dalhaug A, Haukland E. Recursive Partitioning Analysis of Systemic Therapy after Radiotherapy in Patients with Brain Metastases. Oncol Res Treat 2021; 44:86-92. [PMID: 33477159 DOI: 10.1159/000513975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 12/21/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE The purpose of this study was to identify factors associated with the initiation or continuation of systemic treatment after brain irradiation. The outcome of interest was a utilization rate of at least 75%, given that active extracranial disease is common in patients with brain metastases. If left untreated, extracranial disease limits survival, regardless of successful local treatment of the brain metastases. In this context, systemic therapy has been shown to improve survival, e.g., after whole-brain radiotherapy. PATIENTS AND METHODS The study included 185 patients with active extracranial disease, 60% of whom received systemic therapy. RESULTS Survival from the start of brain irradiation was longest in patients who received additional immune checkpoint inhibitors, endocrine treatment, or anti-HER-2 drugs. After uni- and multivariate analyses, Eastern Cooperative Oncology Group performance status (PS) was selected as the first prediction criterion in the recursive partitioning analysis (RPA) decision tree analysis. RPA was successful for patients with PS 0-1, but patients with PS 2 had lower treatment utilization rates (maximum 60-70%, with a disease-dependent impact of age and LabBM score [blood test results]). The highest utilization rates were observed in (1) patients with PS 0 and (2) those with breast cancer, small-cell lung cancer, or lung adenocarcinoma with PS 1. CONCLUSIONS These results inform the multidisciplinary discussion and treatment planning for the common scenario of simultaneous intra- and extracranial metastases.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway, .,Department of Clinical Medicine, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway,
| | - Astrid Dalhaug
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway
| | - Ellinor Haukland
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT, The Arctic University of Norway, Tromsø, Norway
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Fan KY, Lalani N, LeVasseur N, Krauze A, Hsu F, Gondara L, Willemsma K, Nichol AM. Type and timing of systemic therapy use predict overall survival for patients with brain metastases treated with radiation therapy. J Neurooncol 2020; 151:231-240. [PMID: 33206309 DOI: 10.1007/s11060-020-03657-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/28/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION This study aimed to investigate whether systemic therapy (ST) use surrounding radiation therapy (RT) predicts overall survival (OS) after RT for patients with brain metastases (BMs). METHODS Provincial RT and pharmacy databases were used to review all adult patients in British Columbia, Canada, who received a first course of RT for BMs between 2012 and 2016 (n = 3095). Multivariate analysis on a randomly selected subset was used to develop an OS nomogram. RESULTS In comparison to the 2096 non-recipients of ST after RT, the median OS of the 999 recipients of ST after RT was 5.0 (95% Confidence interval (CI) 4.1-6.0) months longer (p < 0.0001). Some types of ST after RT were independently predictive of OS: targeted therapy (hazard ratio (HR) 0.42, CI 0.37-0.48), hormone therapy (HR 0.45, CI 0.36-0.55), cytotoxic chemotherapy (HR 0.71, CI 0.64-0.79), and immunotherapy (HR 0.64, CI 0.37-1.06). Patients who discontinued ST after RT had 0.9 (CI 0.3-1.4) months shorter median OS than patients who received no ST before or after RT (p < 0.0001). In the multivariate analysis of the 220-patient subset, established prognostic variables (extracranial disease, performance status, age, cancer diagnosis, and number of BMs), and the novel variables "ST before RT" and "Type of ST after RT" independently predicted OS. The nomogram predicted 6- and 12-month OS probability and median OS (bootstrap-corrected Harrell's Concordance Index = 0.70). CONCLUSIONS The type and timing of ST use surrounding RT predict OS for patients with BMs.
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Affiliation(s)
| | - Nafisha Lalani
- University of British Columbia, Vancouver, BC, Canada.,BC Cancer, 600 West 10th Ave, Vancouver, BC, V5Z 4E6, Canada
| | - Nathalie LeVasseur
- University of British Columbia, Vancouver, BC, Canada.,BC Cancer, 600 West 10th Ave, Vancouver, BC, V5Z 4E6, Canada
| | - Andra Krauze
- University of British Columbia, Vancouver, BC, Canada.,BC Cancer, 600 West 10th Ave, Vancouver, BC, V5Z 4E6, Canada
| | - Fred Hsu
- University of British Columbia, Vancouver, BC, Canada.,BC Cancer, 600 West 10th Ave, Vancouver, BC, V5Z 4E6, Canada
| | | | | | - Alan McVey Nichol
- University of British Columbia, Vancouver, BC, Canada. .,BC Cancer, 600 West 10th Ave, Vancouver, BC, V5Z 4E6, Canada.
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Validation of recursive partitioning analysis, graded prognostic assessment and basic score for brain metastases as prognostic indices among patients with brain metastases treated with radiotherapy in Indonesia. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396919000463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractIntroduction:Metastatic brain disease is still a major contributor to cancer treatment failure. Various treatments have improved in the recent decades, which allow for better control of brain metastatic lesions. Various prognostic scoring tools have been developed and used worldwide to stratify patients with brain metastases to determine who will benefit most from aggressive treatment. The three most commonly used prognostic scoring tools are recursive partitioning analysis (RPA), basic score for brain metastases (BSBM) and graded prognostic assessment (GPA). The aim of this study is to validate these scoring tools using an Indonesian cancer patient population.Method:A retrospective analysis of all patients presenting with brain metastases from January 2012 until December 2014, through using hospital medical records, was conducted. All patients receiving whole brain radiotherapy during this period were included in this study. A follow-up with a telephone call was carried out to determine the patient’s health and survival status. Uncontactable patients were excluded from the analysis. Survival analysis was carried out by stratifying patients based on the three prognostic scoring systems.Result:A total of 80 patients were eligible to be included in the study, with 18 excluded due to being uncontactable. The remaining 62 patients’ data were analysed and stratified with all three scoring systems. The RPA was found to confer better stratification than BSBM and GPA in our study population.Conclusion:GPA was non-prognostic in our study population and BSBM was less prognostic, especially in the middle group, class 1 and class 2. Those BSBM class 1 and class 2 did not provide good prognostic stratification in our study population, whereas RPA was proven to be the best in stratifying patients’ prognosis with brain metastases in our study population.
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Xiao W, Li X, Yang A, Chen B, Zheng S, Zhang G, Deng W, Liao N. Analysis of Prognostic Factors Affecting the Brain Metastases Free Survival and Survival After Brain Metastases in Breast Cancer. Front Oncol 2020; 10:431. [PMID: 32309214 PMCID: PMC7145983 DOI: 10.3389/fonc.2020.00431] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 03/11/2020] [Indexed: 01/30/2023] Open
Abstract
This study aimed to analyze the factors affecting brain metastases free survival (BMFS) and the survival after brain metastases (SABM). The data of 215 patients with breast cancer brain metastases (BCBM) in Sun Yat-sen University Cancer Center from January 2000 to August 2017 were retrospectively analyzed. The clinicopathological features of BCBM were analyzed, and their effects on BMFS and SABM were analyzed by univariate and multivariate COX regression. Finally, it was analyzed whether the receptor status of the brain metastases and the primary lesions were consistent. The median age of the entire cohort was 46 years old. The median BMFS, SABM and overall survival were 31, 9 and 44.2 months, respectively. Clinical stage, molecular subtypes and bone metastasis were independent prognostic factors affecting BMFS. TNM stage IV (HR, 4.99 [95% CI, 2.13-11.7]) and triple negative subtype (HR, 2.06 [95% CI, 1.35-3.14]) was significantly associated with shorter BMFS, but the presence of bone metastases (HR, 0.63 [95% CI, 0.45-0.88]) was a favorable factor for BMFS. Molecular subtypes, resection of BCBM and whole brain radiotherapy (WBRT) were independent factors for SABM. The triple negative subtype (HR, 2.02[95% CI, 1.12-3.64]) was significantly associated with shorter SABM. However, resection of BCBM (HR, 0.31 [95% CI, 0.15-0.65]) and WBRT (HR, 0.57 [95% CI, 0.35-0.93]) were independent factors in improving SABM. The conversion rate of ER was 11.1%, PR was 29.6%, and HER2 was 3.7% between paired breast cancer and brain metastases. BMFS and SABM have different influencing factors. Resection of BCBM and WBRT can significantly improve SABM. The frequency of HER2 status changes between the paired BCBM and the primary lesions is low.
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Affiliation(s)
- Weikai Xiao
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Xuerui Li
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Anli Yang
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Bo Chen
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Shaoquan Zheng
- Department of Breast Oncology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Guochun Zhang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Wenju Deng
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ning Liao
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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Long-term survival results after treatment for oligometastatic brain disease. Rep Pract Oncol Radiother 2020; 25:307-311. [PMID: 32194350 DOI: 10.1016/j.rpor.2020.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/30/2019] [Accepted: 03/02/2020] [Indexed: 12/28/2022] Open
Abstract
Aim The aim of this study was to characterize the survival results of patients with up to four brain metastases after intense local therapy (primary surgery or stereotactic radiotherapy) if extracranial metastases were absent or limited to one site, e.g. the lungs. Background Oligometastatic disease has repeatedly been reported to convey a favorable prognosis. Material and methods This retrospective study included 198 German and Norwegian patients treated with individualized approaches, always including brain radiotherapy. Information about age, extracranial spread, number of brain metastases, performance status and other variables was collected. Uni- and multivariate tests were performed. Results Median survival was 16.5 months (single brain metastasis) and 9.8 months (2-4, comparable survival for 2, 3 and 4), respectively (p = 0.001). After 5 years, 15 and 2% of the patients were still alive. In patients alive after 2 years, added median survival was 23 months and the probability of being alive 5 years after treatment was 26%. In multivariate analysis, extracranial metastases were not significantly associated with survival, while primary tumor control was. Conclusion Long-term survival beyond 5 years is possible in a minority of patients with oligometastatic brain disease, in particular those with a single brain metastasis. The presence of extracranial metastases to one site should not be regarded a barrier towards maximum brain-directed therapy.
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Nieder C, Hintz M, Popp I, Bilger A, Grosu AL. Validation of the graded prognostic assessment for gastrointestinal cancers with brain metastases (GI-GPA). Radiat Oncol 2020; 15:35. [PMID: 32054485 PMCID: PMC7020357 DOI: 10.1186/s13014-020-1484-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 02/04/2020] [Indexed: 02/06/2023] Open
Abstract
PURPOSE The purpose of this study was to validate a new prognostic model (GI-GPA) originally derived from a multi-center database (USA, Canada, Japan). PATIENTS AND METHODS This retrospective study included 92 German and Norwegian patients treated with individualized approaches, always including brain radiotherapy. Information about age, extracranial spread, number of brain metastases, performance status and other variables was collected. The GI-GPA score was calculated as described by Sperduto et al. RESULTS: Median survival was 4 months. The corresponding figures for the 4 different prognostic strata were 2.3, 4.4, 9.4 and 12.7 months, respectively (p = 0.0001). Patients whose management included surgical resection had longer median survival than those who were treated with other approaches (median 11.9 versus 3.0 months, p = 0.002). Comparable results were seen for additional systemic therapy (median 8.5 versus 3.5 months, p = 0.01). CONCLUSION These results confirm the validity of the GI-GPA in an independent dataset from a different geographical region, despite the fact that overall survival was shorter in all prognostic strata, compared to Sperduto et al. Potential explanations include differences in molecular tumor characteristics and treatment selection, both brain metastases-directed and extracranially. Long-term survival beyond 5 years is possible in a small minority of patients.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, 8092, Bodø, Norway. .,Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, 9037, Tromsø, Norway.
| | - Mandy Hintz
- Department of Radiation Oncology, University Hospital Freiburg, 79106, Freiburg, Germany
| | - Ilinca Popp
- Department of Radiation Oncology, University Hospital Freiburg, 79106, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Angelika Bilger
- Department of Radiation Oncology, University Hospital Freiburg, 79106, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
| | - Anca L Grosu
- Department of Radiation Oncology, University Hospital Freiburg, 79106, Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, Freiburg, Germany
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Duan H, Zheng SY, Zhou T, Cui HJ, Hu KW. Temozolomide plus whole brain radiotherapy for the treatment of non-small-cell lung cancer patients with brain metastases: A protocol of an updated systematic review and meta-analysis. Medicine (Baltimore) 2020; 99:e18455. [PMID: 32000358 PMCID: PMC7004645 DOI: 10.1097/md.0000000000018455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Whole brain radiotherapy (WBRT) has been the mainstay treatment of brain metastases (BM) in non-small cell lung cancer (NSCLC) patients for years. Temozolomide (TMZ) could penetrate the blood-brain barrier and some studies showed that TMZ plus MBRT may improve clinical effectiveness. This meta-analysis is aim to evaluate the clinical effectiveness and safety of TMZ plus MBRT in the NSCLC patients with BM. METHODS AND ANALYSIS We systematically searched databases including PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and four Chinese databases (Chinese Biomedical Database, China National Knowledge Infrastructure, Wanfang Database and Chinese Scientific Journal Database) without language restrictions from inception until July 26, 2019. Randomized controlled trials (RCTs) which compared TMZ plus WBRT with single WBRT in the advanced NSCLC patients with BM were included. The outcomes analysis reported objective response rate (ORR), disease control rate (DCR), overall survival (OS), progression-free survival (PFS), quality of life (QOL), and adverse effects. Two reviewers will independently extract data from the selected studies and assess the quality of studies. Statistical analyses will be performed using Review manager 5.3 software. Random-effects or fixed models were used to estimate pooled hazard ratio and relative risk. RESULTS This systemic review and meta-analysis will evaluate the effects of TMZ plus MBRT in the NSCLC patients with BM in RCTs. CONCLUSION Our study will provide evidence to judge if TMZ plus MBRT are effective treatment for NSCLC patients with BM.
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Affiliation(s)
- Hua Duan
- Beijing University of Chinese Medicine
- Oncology Department, Dongfang Hospital, Beijing University of Chinese Medicine
| | - Shu-Yue Zheng
- Beijing University of Chinese Medicine
- Department of Integrative Oncology, China-Japan Friendship Hospital, Beijing, China
| | - Tian Zhou
- Oncology Department, Dongfang Hospital, Beijing University of Chinese Medicine
| | - Hui-Juan Cui
- Department of Integrative Oncology, China-Japan Friendship Hospital, Beijing, China
| | - Kai-Wen Hu
- Oncology Department, Dongfang Hospital, Beijing University of Chinese Medicine
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10
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Al-Khindi T, Shen CJ, Peng L, Redmond KJ, Lim M, Kleinberg LR, Bettegowda C. Assessing the Effectiveness of Systemic Therapy after Stereotactic Radiosurgery on Cancer Recurrence and All-Cause Mortality. World Neurosurg 2019; 129:e572-e581. [PMID: 31158536 DOI: 10.1016/j.wneu.2019.05.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 05/25/2019] [Accepted: 05/27/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Patients with cancer often present with brain metastases in the setting of controlled extracranial disease, for which they receive stereotactic radiosurgery (SRS) and surgical resection. The role of systemic therapy after SRS is unclear. Brain metastasis indicates active cancer dissemination, and microscopic systemic disease may be present despite absence of gross disease as assessed by conventional imaging modalities. OBJECTIVE The aim was to determine if post-SRS systemic therapy reduces the risk of brain relapse, systemic relapse, and death in patients with brain metastases and controlled extracranial disease. METHODS We retrospectively reviewed the medical records of 67 patients with controlled extracranial disease who received SRS for brain metastases. Kaplan-Meier analysis and Cox proportional hazards regression were used to assess how post-SRS systemic therapy affected the risk of brain relapse, systemic relapse, and all-cause mortality. RESULTS In our sample, 31% of patients received systemic therapy after SRS. Post-SRS systemic therapy did not affect median time to brain relapse (P = 0.43), systemic relapse (P = 0.16), or death (P = 0.33) by univariate analysis. After accounting for confounding factors such as cancer histology and age, post-SRS systemic therapy significantly reduced the risk of brain relapse (hazard ratio [HR], 0.22; P = 0.002) but not systemic relapse (HR, 0.38; P = 0.09) or all-cause mortality (HR, 2.16; P = 0.09). CONCLUSIONS Only a minority of patients with brain metastases and controlled extracranial disease receive adjuvant systemic therapy after SRS, but those that do have a reduced risk of brain relapse. Post-SRS systemic therapy may act prophylactically to reduce the risk of intracranial cancer recurrence.
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Affiliation(s)
- Timour Al-Khindi
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Colette J Shen
- Department of Radiation Oncology, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Luke Peng
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kristin J Redmond
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael Lim
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Lawrence R Kleinberg
- Department of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Chetan Bettegowda
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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Nieder C, Yobuta R, Mannsåker B. Patterns of Treatment and Outcome in Patients With 20 or More Brain Metastases. In Vivo 2019; 33:173-176. [PMID: 30587619 DOI: 10.21873/invivo.11455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 11/12/2018] [Accepted: 11/15/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND/AIM The aim of this study was to analyze the patterns of treatment and outcomes in patients with a large number of brain metastases, arbitrarily defined as 20 or more lesions. These patients are typically excluded from studies of focal brain treatment, e.g., surgery or radiosurgery, and might have a limited prognosis. PATIENTS AND METHODS This was a retrospective single-institution analysis. Overall, 11 patients were identified from a prospectively maintained database. RESULTS Ten patients had received active treatment (9 whole-brain radiotherapy, 7 systemic therapy). Median survival was 5.0 months without long-term survival beyond 13 months. Patients with better performance status had numerically longer survival, however we did not identify baseline parameters with a significant impact on survival. CONCLUSION While long-term survival was not observed in this small study, most patients survived long enough to experience symptomatic improvement from whole-brain radiotherapy. Therefore, we recommend multidisciplinary assessment of the patients' prognosis and systemic treatment options, and initiation of whole-brain radiotherapy if survival is not limited to 1-2 months.
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Affiliation(s)
- Carsten Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway .,Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Rosalba Yobuta
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway
| | - Bård Mannsåker
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway
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12
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Nieder C, Yobuta R, Mannsåker B. Second Re-irradiation of Brain Metastases: A Review of Studies Involving Stereotactic Radiosurgery. Cureus 2018; 10:e3712. [PMID: 30788201 PMCID: PMC6373883 DOI: 10.7759/cureus.3712] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Due to advances in the systemic and local treatment, e.g., targeted therapy, immune checkpoint inhibitors, and stereotactic radiotherapy, an increasing proportion of patients with brain metastases now survive for several years. However, long-term survival is not synonymous to permanent local control in the brain. Both local and distant brain relapse sometimes necessitate additional radiotherapy to prevent death from neurologic causes. Prescribing more than two courses of radiotherapy to the same target volume or, in this case, brain metastasis, is a controversial approach. The present review summarizes the results of clinical studies, that included patients treated with whole-brain radiotherapy (WBRT) and two courses of stereotactic radiotherapy to the same, locally recurrent metastasis, and with two courses of WBRT and an additional stereotactic radiotherapy.
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Matzenauer M, Vrana D, Melichar B. Treatment of brain metastases. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2016; 160:484-490. [PMID: 27876898 DOI: 10.5507/bp.2016.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 11/10/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Brain metastases are a very common neurological sequela in cancer patients. The ability of current anti-cancer therapies to prolong overall survival is beleaguered by this development in the case of a number of different cancers. This review provides a general overview of relevant treatment modalities, highlights major decision strategies used in selecting the optimal treatment algorithm and summarizes important steps necessary before initiating therapy. METHODS A PubMed database search was done to identify publications describing the treatment of brain metastases including surgery, radiotherapy and symptomatic care. RESULTS AND CONCLUSION Patient performance status and extent of disease play the most important roles in selecting between an aggressive or more conservative approach. As several other options are available, treatment decisions should be made in cooperation with multiple medical specialties and the involvement of multidisciplinary teams. In the future, brain metastases could become less of a treatment obstacle than they are today.
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Affiliation(s)
- Marcel Matzenauer
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic
| | - David Vrana
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.,Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic.,Toxicogenomics Unit, National Institute of Public Health, Prague, Czech Republic
| | - Bohuslav Melichar
- Department of Oncology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Czech Republic.,Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
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