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Kinj R, Hottinger AF, Böhlen TT, Ozsahin M, Vallet V, Dunet V, Bouchaab H, Peters S, Tuleasca C, Bourhis J, Schiappacasse L. Long-Term Results of Stereotactic Radiotherapy in Patients with at Least 10 Brain Metastases at Diagnosis. Cancers (Basel) 2024; 16:1742. [PMID: 38730695 PMCID: PMC11083879 DOI: 10.3390/cancers16091742] [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: 04/05/2024] [Revised: 04/24/2024] [Accepted: 04/28/2024] [Indexed: 05/13/2024] Open
Abstract
PURPOSE to evaluate an SRT approach in patients with at least 10 lesions at the time of BM initial diagnosis. METHODS This is a monocentric prospective cohort of patients treated by SRT, followed by a brain MRI every two months. Subsequent SRT could be delivered in cases of new BMs during follow-up. The main endpoints were local control rate (LCR), overall survival (OS), and strategy success rate (SSR). Acute and late toxicity were evaluated. RESULTS Seventy patients were included from October 2014 to January 2019, and the most frequent primary diagnosis was non-small-cell lung cancer (N = 36, 51.4%). A total of 1174 BMs were treated at first treatment, corresponding to a median number of 14 BMs per patient. Most of the patients (N = 51, 72.6%) received a single fraction of 20-24 Gy. At 1 year, OS was 62.3%, with a median OS of 19.2 months, and SSR was 77.8%. A cumulative number of 1537 BM were treated over time, corresponding to a median cumulative number of 16 BM per patient. At 1-year, the LCR was 97.3%, with a cumulative incidence of radio-necrosis of 2.1% per lesion. Three patients (4.3%) presented Grade 2 toxicity, and there was no Grade ≥ 3 toxicity. The number of treated BMs and the treatment volume did not influence OS or SSR (p > 0.05). CONCLUSIONS SRT was highly efficient in controlling the BM, with minimal side effects. In this setting, an SRT treatment should be proposed even in patients with ≥10 BMs at diagnosis.
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Affiliation(s)
- Rémy Kinj
- Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, CHUV, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
- Lundin Family Brain Tumor Centre, Departments of Oncology & Clinical Neurosciences, Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Andreas Felix Hottinger
- Lundin Family Brain Tumor Centre, Departments of Oncology & Clinical Neurosciences, Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland
- Departments of Medical Oncology & Clinical Neurosciences, Lausanne University Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Till Tobias Böhlen
- Lundin Family Brain Tumor Centre, Departments of Oncology & Clinical Neurosciences, Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland
- Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Mahmut Ozsahin
- Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, CHUV, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Véronique Vallet
- Institute of Radiation Physics, Lausanne University Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Vincent Dunet
- Lundin Family Brain Tumor Centre, Departments of Oncology & Clinical Neurosciences, Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland
- Departement of Medical Radiology, Lausanne University Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Hasna Bouchaab
- Departments of Medical Oncology, Lausanne University Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Solange Peters
- Departments of Medical Oncology, Lausanne University Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Constantin Tuleasca
- Lundin Family Brain Tumor Centre, Departments of Oncology & Clinical Neurosciences, Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland
- Department of Clinical Neurosciences, Neurosurgery Service and Gamma Knife Center, Lausanne University Hospital, University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Jean Bourhis
- Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, CHUV, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
- Lundin Family Brain Tumor Centre, Departments of Oncology & Clinical Neurosciences, Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Luis Schiappacasse
- Department of Radiation Oncology, Lausanne University Hospital and University of Lausanne, CHUV, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
- Lundin Family Brain Tumor Centre, Departments of Oncology & Clinical Neurosciences, Hospital and University of Lausanne, CH-1011 Lausanne, Switzerland
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McKibben NS, MacConnell AE, Chen Y, Gao L, Nguyen TM, Brown SA, Jaboin JJ, Lin C, Baksh NH. Risk Factors for Radiotherapy Failure in the Treatment of Spinal Metastases. Global Spine J 2023:21925682231213290. [PMID: 37941315 DOI: 10.1177/21925682231213290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To build a predictive model for risk factors for failure of radiation therapy, hypothesizing a higher SINS would correlate with failure. METHODS Patients with spinal metastasis being treated with radiation at a tertiary care academic center between September 2014 and October 2018 were identified. The primary outcome measure was radiation therapy failure as defined by persistent pain, need for re-irradiation, or surgical intervention. Risk factors were primary tumor type, Karnofsky and ECOG scores, time to treatment, biologically effective dose (BED) calculations using α/β ratio = 10, and radiation modality. A logistic regression was used to construct a prediction model for radiation therapy failure. RESULTS One hundred and seventy patients were included. Median follow up was 91.5 days. Forty-three patients failed radiation therapy. Of those patients, 10 required repeat radiation and 7 underwent surgery. Thirty-six patients reported no pain relief, including some that required re-irradiation and surgery. Total SINS score for those who failed reduction therapy was <7 for 27 patients (62.8%), between 7-12 for 14 patients (32.6%), and >12 for 2 patients (4.6%). In the final prediction model, BED (OR .451 for BED > 43 compared to BED ≤ 43; P = .174), Karnofksy score (OR .736 for every 10 unit increase in Karnofksy score; P = .008), and gender (OR 2.147 for male compared to female; P = .053) are associated with risk of radiation failure (AUC .695). A statistically significant association between SINS score and radiation therapy failure was not found. CONCLUSIONS In the multivariable model, BED ≤ 43, lower Karnofksy score, and male gender are predictive for radiotherapy failure. SINS score was among the candidate risk factors included in multivariable model building procedure, but it was not selected in the final model. LEVEL OF EVIDENCE Prognostic level III.
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Affiliation(s)
- Natasha S McKibben
- School of Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Ashley E MacConnell
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
| | - Yiyi Chen
- Department of Radiation Oncology, Oregon Health and Science University, Portland, OR, USA
- Biostatistics Shared Resources of Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Lina Gao
- Biostatistics Shared Resources of Knight Cancer Institute, Oregon Health and Science University, Portland, OR, USA
| | - Thuy M Nguyen
- Department of Orthopaedic Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Simon A Brown
- Department of Radiation Oncology, Oregon Health and Science University, Portland, OR, USA
| | - Jerry J Jaboin
- Department of Radiation Oncology, Oregon Health and Science University, Portland, OR, USA
| | - Clifford Lin
- Department of Orthopaedic Surgery, Oregon Health and Science University, Portland, OR, USA
| | - Nikolas H Baksh
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
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Silva SB, Barreto RB, de Oliveira FCG, Martin GSD, Takiguchi OMY, Chirichela IA, Miranda MHF, Bodnar D, Alves Reis LA, Pereira GCB, Miranda IL, Pereira BR, Arruda GV, Peria FM. Radiotherapy for Brain Metastases Near the End of Life: Characterizing Patients and Tumor Features. JCO Glob Oncol 2023; 9:e2300143. [PMID: 37883725 PMCID: PMC10664862 DOI: 10.1200/go.23.00143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 07/25/2023] [Accepted: 08/30/2023] [Indexed: 10/28/2023] Open
Abstract
PURPOSE Patients with brain metastases are often referred for brain radiotherapy (BrRT) when exclusive palliative management would be more appropriate. To assess the indication of BrRT during end-of-life (EOL) care and evaluate the characteristics of the patients who underwent the treatment. METHODS This retrospective study comprised patients from four independent oncology centers who had undergone BrRT for metastases. The variables included were Karnofsky performance status (KPS), primary tumor site, metastatic status, neurologic symptomatic status, the number and size of metastases, posterior fossa or meningeal involvement, type of BrRT, having undergone brain metastasectomy, and the availability of systemic therapies after BrRT. Patients were allocated into three subgroups with ≤30, 31-60, and 61-90 days of survival, and a control group of patients who survived >90 days. RESULTS A total of 546 patients were included in the study. A KPS of <70 (P = .021), the number of brain metastases (P = .001), the lack of brain metastasectomy (P = .006), and the lack of systemic therapies after BrRT (P = .047) were significantly associated with the EOL subgroups. Multivariate analysis showed that a KPS of <70 (P < .001), the lack of brain metastasectomy (P = .015), and the lack of systemic therapies after BrRT (P = .027) were significantly associated with worse survival. In all, 241 (44.1%) patients died within 90 days-120 (22.0%) within 30 days, 75 (13.7%) within 31-60 days, and 46 (8.4%) within 61-90 days of BrRT. Patients with colorectal cancer were significantly more likely to die within 90 days of BrRT than >90 days. CONCLUSION Considering patients' performance status and whether they are candidates for brain metastasectomy or systemic therapies after BrRT is critical to improving BrRT benefits in scenarios of EOL.
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Affiliation(s)
- Saulo Brito Silva
- Department of Medical Imaging, Hematology, and Oncology; Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Gabriela Schmidt Defende Martin
- Department of Medical Imaging, Hematology, and Oncology; Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil
| | - Ofelia Maria Yukie Takiguchi
- Department of Medical Imaging, Hematology, and Oncology; Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil
| | - Iasmin Alves Chirichela
- Department of Medical Imaging, Hematology, and Oncology; Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil
| | | | - Denize Bodnar
- Centro de Pesquisas Oncológicas—CEPON, Florianópolis, SP, Brazil
| | | | | | | | | | - Gustavo Viani Arruda
- Department of Medical Imaging, Hematology, and Oncology; Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil
| | - Fernanda Maris Peria
- Department of Medical Imaging, Hematology, and Oncology; Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, São Paulo, Brazil
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Socha J, Rychter A, Kepka L. Management of brain metastases in elderly patients with lung cancer. J Thorac Dis 2021; 13:3295-3307. [PMID: 34164222 PMCID: PMC8182516 DOI: 10.21037/jtd-2019-rbmlc-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The incidence of brain metastases (BM) is continuing to grow in the elderly population with lung cancer, but these patients are seriously under-represented in clinical trials. Thus, their treatment is not based on the evidence from randomized prospective studies. Age is a well recognized poor prognostic factor for survival in patients with BM from lung cancer, which is reflected in prognostic scales, but its impact on the patients' prognosis reflected by its value in gradually updated grading indices seems to decrease. The reason for poorer outcomes in the elderly is unknown—it may result from the influence of the age per se, simplified staging work-up and suboptimal treatment in this patient subgroup or the excess toxicity of the aggressive anticancer treatment secondary to the impaired physiological regulation mechanisms and comorbidities. The main goal of treatment of BM is to ameliorate neurological symptoms and delay neurological progression, with the focus on the improvement and maintenance of the patients’ quality of life. The possible treatment options for BM from lung cancer are whole-brain radiotherapy, stereotactic radiosurgery, surgery, chemotherapy, targeted therapies and best supportive care. The aim of this review is to summarize the problems related to the management of BM in elderly patients with lung cancer, to analyze the value of the above mentioned treatment options, and to provide an insight into the influence of age-related clinical factors on the patients’ outcomes.
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Affiliation(s)
- Joanna Socha
- Department of Radiotherapy, Military Institute of Medicine, Warsaw, Poland.,Department of Radiotherapy, Regional Oncology Centre, Czestochowa, Poland
| | - Anna Rychter
- Department of Radiotherapy, Military Institute of Medicine, Warsaw, Poland
| | - Lucyna Kepka
- Department of Radiotherapy, Military Institute of Medicine, Warsaw, Poland
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Chen Y, Li J, Zhang Y, Hu Y, Zhang G, Yan X, Lin Z, Zhao Z, Jiao S. Early versus late prophylactic cranial irradiation in patients with extensive small cell lung cancer. Strahlenther Onkol 2018; 194:876-885. [DOI: 10.1007/s00066-018-1307-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 04/23/2018] [Indexed: 01/08/2023]
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Jeene PM, de Vries KC, van Nes JGH, Kwakman JJM, Wester G, Rozema T, Braam PM, Zindler JD, Koper P, Nuyttens JJ, Vos-Westerman HA, Schmeets I, Niël CGHJ, Hutschemaekers S, van der Linden YM, Verhoeff JJC, Stalpers LJA. Survival after whole brain radiotherapy for brain metastases from lung cancer and breast cancer is poor in 6325 Dutch patients treated between 2000 and 2014. Acta Oncol 2018; 57:637-643. [PMID: 29276848 DOI: 10.1080/0284186x.2017.1418534] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Whole brain radiotherapy (WBRT) is considered standard of care for patients with multiple brain metastases or unfit for radical treatment modalities. Recent studies raised discussion about the expected survival after WBRT. Therefore, we analysed survival after WBRT for brain metastases 'in daily practice' in a large nationwide multicentre retrospective cohort. METHODS Between 2000 and 2014, 6325 patients had WBRT (20 Gy in 4 Gy fractions) for brain metastases from non-small cell lung cancer (NSCLC; 4363 patients) or breast cancer (BC; 1962 patients); patients were treated in 15 out of 21 Dutch radiotherapy centres. Survival was calculated by the Kaplan-Meier method from the first day of WBRT until death as recorded in local hospital data registration or the Dutch Municipal Personal Records Database. FINDINGS The median survival was 2.7 months for NSCLC and 3.7 months for BC patients (p < .001). For NSCLC patients aged <50, 50-60, 60-70 and >70 years, survival was 4.0, 3.0, 2.8 and 2.1 months, respectively (p < .001). For BC patients, survival was 4.5, 3.8, 3.2 and 2.9 months, respectively (p = .047). In multivariable analyses, higher age was related to poorer survival with hazard ratios (HR) for patients aged 50-60, 60-70 and >70 years being 1.05, 1.19 and 1.34, respectively. Primary BC (HR: 0.83) and female sex (HR: 0.85) were related to better survival (p < .001). INTERPRETATION The survival of patients after WBRT for brain metastases from NSCLC treated in Dutch 'common radiotherapy practice' is poor, in breast cancer and younger patients it is disappointingly little better. These results are in line with the results presented in the QUARTZ trial and we advocate a much more restrictive use of WBRT. In patients with a more favourable prognosis the optimal treatment strategy remains to be determined. Prospective randomized trials and individualized prognostic models are needed to identify these patients and to tailor treatment.
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Affiliation(s)
- Paul M. Jeene
- Department of Radiotherapy, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Radiotherapiegroep, Deventer, The Netherlands
| | - Kim C. de Vries
- Department of Radiotherapy, Antoni van Leeuwenhoek ziekenhuis, Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Johannes J. M. Kwakman
- Department of Radiotherapy, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Tom Rozema
- Instituut Verbeeten, Tilburg, The Netherlands
| | - Pètra M. Braam
- Department of Radiotherapy, RadboudUMC, Nijmegen, The Netherlands
| | - Jaap D. Zindler
- MAASTRO Clinic Maastricht, GROW School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Peter Koper
- Department of Radiotherapy, HaaglandenMC, The Hague, The Netherlands
| | - Joost J. Nuyttens
- Department of Radiotherapy, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Ilona Schmeets
- Department of Radiotherapy, Catharina ziekenhuis, Eindhoven, The Netherlands
| | | | | | | | - Joost J. C. Verhoeff
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lukas J. A. Stalpers
- Department of Radiotherapy, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Abstract
Melanoma is the malignancy with the highest rate of dissemination to the central nervous system once it metastasizes. Until recently, the prognosis of patients with melanoma brain metastases (MBM) was poor. In recent years, however, the prognosis has improved due to high-resolution imaging that facilitates early detection of small asymptomatic brain metastases and early intervention with local modalities such as stereotactic radiosurgery. More recently, a number of systemic therapies have been approved by the Food and Drug Administration for metastatic melanoma, resulting in improved survival for many MBM patients. Registration trials for these newer therapies excluded patients with untreated brain metastases, and a number of studies specifically tailored to this population of patients have been conducted or are underway. Herein, we review contemporary locoregional and systemic therapies and describe the unique challenges posed by treatment of brain metastases, such as radionecrosis, cerebral edema, and pseudoprogression. Since the number of systemic and combined modality clinical trials has increased, we expect that the treatment landscape for patients with melanoma brain metastasis will change dramatically. In addition to ongoing clinical trials, which show great promise, we conclude that our understanding of intracranial metastasis remains quite limited. In addition to inter-disciplinary, multi-modality studies, bench-side work to better understand the process of cerebrotropism is needed to fuel more drug development and further improve outcomes.
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Examination of the predictive factors of the response to whole brain radiotherapy for brain metastases from lung cancer using MRI. Oncol Lett 2017; 14:1073-1079. [PMID: 28693276 DOI: 10.3892/ol.2017.6264] [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: 06/21/2016] [Accepted: 03/09/2017] [Indexed: 11/05/2022] Open
Abstract
Previous studies have been conducted on the prognostic factors for overall survival in patients with brain metastases (BMs) following whole brain radiotherapy (WBRT). However, there have been a small number of studies regarding the prognostic factors for the response of tumor to WBRT. The aim of the present study was to identify the predictive factors for the response to WBRT from the point of view of reduction of tumor using magnetic resonance imaging. A retrospective analysis of 62 patients with BMs from primary lung cancer treated with WBRT was undertaken. The effects of the following factors on the response to WBRT were evaluated: Age; sex; performance status; lactate dehydrogenase; pathology; existence of extracranial metastases; activity of extracranial disease; chemo-history; chest radiotherapy history; treatment term; γ-knife radiotherapy; diffusion weighted image signal intensity; tumor diameter; extent of edema and the edema/tumor (E/T) ratio. The association between the reduction of tumors and clinical factors was evaluated using logistic regression analysis. P<0.05 was considered to indicate a statistically significant difference. The overall response ratio of this cohort was 54.8%. In the univariate analysis, the response of tumors was associated with the presence of small cell lung carcinoma (SCLC; P=0.0007), an E/T ratio of ≥1.5 (P=0.048), and a median tumor diameter of <20 mm (P=0.014). In the multivariate analysis, the presence of SCLC [P=0.001; odds ratio (OR), 17.152), an E/T ratio of ≥1.5 (P=0.019; OR, 9.526), and the presence of extracranial metastases (P=0.031; OR, 4.875) were revealed to be independent predictive factors for the reduction of tumor. The following 3 factors were significantly associated with the response of tumors to WBRT: The presence of SCLC; an E/T ratio of ≥1.5; and the presence of extracranial metastases. The E/T ratio is a novel index that provides a simple and easy predictive method for use in a clinical setting.
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Mege D, Sans A, Ouaissi M, Iannelli A, Sielezneff I. Brain metastases from colorectal cancer: characteristics and management. ANZ J Surg 2017; 88:140-145. [PMID: 28687024 DOI: 10.1111/ans.14107] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/05/2017] [Accepted: 05/14/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Brain metastases (BMs) are the most common intracranial neoplasms in adults, but they rarely arise from colorectal cancer (CRC). The objective of this study was to report an overview of the characteristics and current management of CRC BMs. METHODS A systematic review on CRC BMs was performed using Medline database from 1983 to 2015. The search was limited to studies published in English. Review articles, not relevant case report or studies or studies relating to animal and in vitro experiments were excluded. RESULTS BMs occurred in 0.06-4% of patients with CRC. Most BMs were metachronous and were associated with lung (27-92%) and liver (12-80%) metastases. Treatment options depended on the number of BMs, the general conditions of the patient and the presence of other metastases. Most frequent treatment was whole-brain radiotherapy (WBRT) alone (36%), with median overall survival comprised between 2 and 9 months. Median overall survival was better after surgery alone (from 3 to 16.2 months), or combined with WBRT (from 7.6 to 14 months). After stereotactic radiosurgery alone, overall survival could reach 9.5 months. Many favourable prognostic factors were identified, such as high Karnofsky performance status, low recursive partitioning analysis classes, lack of extracranial disease, low number of BMs and possibility to perform surgical treatment. CONCLUSION BMs from CRC are rare. In the presence of favourable prognostic factors, an aggressive management including surgical resection with or without WBRT or stereotactic radiosurgery can improve the overall survival.
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Affiliation(s)
- Diane Mege
- Department of Digestive and General Surgery, Timone Hospital, Aix-Marseille University, Marseille, France
| | - Arnaud Sans
- Department of Digestive and General Surgery, Timone Hospital, Aix-Marseille University, Marseille, France
| | - Mehdi Ouaissi
- Department of Digestive Surgery, University of Tours, Tours, France
| | - Antonio Iannelli
- Department of Digestive Surgery, Archet II Hospital, University of Nice-Sophia-Antipolis, Nice, France
| | - Igor Sielezneff
- Department of Digestive and General Surgery, Timone Hospital, Aix-Marseille University, Marseille, France
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Manapov F, Eze C. Prophylactic cranial irradiation in small-cell lung cancer. Lancet Oncol 2017; 18:e366. [PMID: 28677569 DOI: 10.1016/s1470-2045(17)30402-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 04/26/2017] [Accepted: 04/27/2017] [Indexed: 01/05/2023]
Affiliation(s)
- Farkhad Manapov
- Department of Radiation Oncology, LMU Munich, 81377 Munich, Germany.
| | - Chukwuka Eze
- Department of Radiation Oncology, LMU Munich, 81377 Munich, Germany
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Patla A, Walasek T, Jakubowicz J, Blecharz P, Mituś JW, Mucha-Małecka A, Reinfuss M. Methods and results of locoregional treatment of brain metastases in patients with non-small cell lung cancer. Contemp Oncol (Pozn) 2016; 20:358-364. [PMID: 28373816 PMCID: PMC5371699 DOI: 10.5114/wo.2015.51825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 07/01/2014] [Indexed: 11/17/2022] Open
Abstract
This article presents methods and results of surgery and radiotherapy of brain metastases from non-small cell lung cancer (BMF-NSCLC). Patients with single BMF-NSCLC, with Karnofsky score ≥ 70 and controlled extracranial disease are the best candidates for surgery. Stereotactic radiosurgery (SRS) is recommended in patients with 1-3 BMF-NSCLC below 3-3.5 cm, with minor neurological symptoms, located in parts of the brain not accessible to surgery, with controlled extracranial disease. Whole brain radiotherapy (WBRT) following SRS reduces the risk of local relapse; in selected patients median survival reaches more than 10 months. Whole brain radiotherapy alone is a treatment in patients with multiple metastases, poor performance status, uncontrolled extracranial disease, disqualified from surgery or SRS with median survival 3 to 6 months. There is no doubt that there are patients with BMF-NSCLC who should receive only the best supportive care. There is a debate in the literature on how to select these patients.
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Affiliation(s)
- Anna Patla
- Department of Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow Branch, Poland
| | - Tomasz Walasek
- Department of Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow Branch, Poland
| | - Jerzy Jakubowicz
- Department of Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow Branch, Poland
| | - Paweł Blecharz
- Department of Gynaecological Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow Branch, Poland
| | - Jerzy Władysław Mituś
- Department of Surgical Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow Branch, Poland
| | - Anna Mucha-Małecka
- Department of Oncology, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow Branch, Poland
| | - Marian Reinfuss
- Department of Radiotherapy, Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Krakow Branch, Poland
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Yomo S, Hayashi M. Is upfront stereotactic radiosurgery a rational treatment option for very elderly patients with brain metastases? A retrospective analysis of 106 consecutive patients age 80 years and older. BMC Cancer 2016; 16:948. [PMID: 27978813 PMCID: PMC5160012 DOI: 10.1186/s12885-016-2983-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 12/05/2016] [Indexed: 11/24/2022] Open
Abstract
Background Advanced age has been shown to be a factor predicting poor survival in patients with brain metastases (BM). There have been only a few studies focusing on stereotactic radiosurgery (SRS) for elderly BM patients. The present study aimed to investigate the efficacy and limitations of SRS for very elderly BM patients. Methods This was a retrospective observational study analyzing 106 consecutive patients (69 males/37 females) age 80 years and older who received upfront Gamma Knife SRS for BM between January 2009 and October 2015. The median age was 84 years, and the median Karnofsky performance status (KPS) was 70. Fifty-two patients had a solitary BM, and others multiple BM. The median cumulative tumor volume was 3.9 mL and the median dose prescribed was 20 Gy. Overall survival (OS), neurological death rates and distant and local intracranial tumor control rates were analyzed. Results No patients were lost to follow-up. Six-month and 12-month OS rates were 54% and 32%, respectively. The median OS time was 7.1 months. Competing risks analysis showed that 6-month and 12-month neurological death rates were 8% and 11%, respectively. In total, 245 / 311 tumors (79%) in 82 patients (77%) with sufficient radiological follow-up data were evaluated. Six-month and 12-month distant BM recurrence rates (per patient) after SRS were 17% and 25%, respectively. Six-month and 12-month rates of local tumor control (per lesion) were 94% and 89%, respectively. Repeat SRS, salvage WBRT and surgical resection were subsequently required in 25, 4 and 1 patient, respectively. Proportional hazard regression analysis showed that KPS ≥ 70 (HR: 0.444, P < .001), controlled primary disease/no extracranial metastases (HR: 0.361, P < .001) and female sex (HR: 0.569, P = 0.028) were independent factors predicting better OS. Similarly, tumor volume (>2 mL) was the only factor predicting a higher rate of local control failure (HR: 12.8, P = 0.003). Conclusions The present study suggested an upfront SRS strategy to offer a feasible and effective treatment option for very elderly patients with limited BM. In the majority of patients, neurological death could be delayed or even prevented.
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Affiliation(s)
- Shoji Yomo
- Division of Radiation Oncology, Aizawa Comprehensive Cancer Center, Aizawa Hospital, 2-5-1, Honjo, Matsumoto-city, Nagano-prefecture, 390-0814, Japan. .,Saitama Gamma Knife Center, San-ai Hospital, Saitama-city, Saitama-prefecture, Japan.
| | - Motohiro Hayashi
- Saitama Gamma Knife Center, San-ai Hospital, Saitama-city, Saitama-prefecture, Japan
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13
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Rodin D, Banihashemi B, Wang L, Lau A, Harris S, Levin W, Dinniwell R, Millar BA, Chung C, Laperriere N, Bezjak A, Wong RKS. The Brain Metastases Symptom Checklist as a novel tool for symptom measurement in patients with brain metastases undergoing whole-brain radiotherapy. ACTA ACUST UNITED AC 2016; 23:e239-47. [PMID: 27330360 DOI: 10.3747/co.23.2936] [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] [Indexed: 11/15/2022]
Abstract
PURPOSE We evaluated the feasibility, reliability, and validity of the Brain Metastases Symptom Checklist (bmsc), a novel self-report measure of common symptoms experienced by patients with brain metastases. METHODS Patients with first-presentation symptomatic brain metastases (n = 137) referred for whole-brain radiotherapy (wbrt) completed the bmsc at time points before and after treatment. Their caregivers (n = 48) provided proxy ratings twice on the day of consultation to assess reliability, and at week 4 after wbrt to assess responsiveness to change. Correlations with 4 other validated assessment tools were evaluated. RESULTS The symptoms reported on the bmsc were largely mild to moderate, with tiredness (71%) and difficulties with balance (61%) reported most commonly at baseline. Test-retest reliability for individual symptoms had a median intraclass correlation of 0.59 (range: 0.23-0.85). Caregiver proxy and patient responses had a median intraclass correlation of 0.52. Correlation of absolute scores on the bmsc and other symptom assessment tools was low, but consistency in the direction of symptom change was observed. At week 4, change in symptoms was variable, with improvements in weight gain and sleep of 42% and 41% respectively, and worsening of tiredness and drowsiness of 62% and 59% respectively. CONCLUSIONS The bmsc captures a wide range of symptoms experienced by patients with brain metastases, and it is sensitive to change. It demonstrated adequate test-retest reliability and face validity in terms of its responsiveness to change. Future research is needed to determine whether modifications to the bmsc itself or correlation with more symptom-specific measures will enhance validity.
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Affiliation(s)
- D Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, ON
| | - B Banihashemi
- Department of Radiation Oncology, Lakeridge Health Corporation, Oshawa, ON
| | - L Wang
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON
| | - A Lau
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, ON
| | - S Harris
- Palliative Radiation Oncology Program, Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON
| | - W Levin
- Department of Radiation Oncology, University of Toronto, Toronto, ON;; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON
| | - R Dinniwell
- Department of Radiation Oncology, University of Toronto, Toronto, ON;; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON
| | - B A Millar
- Department of Radiation Oncology, University of Toronto, Toronto, ON;; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON
| | - C Chung
- Department of Radiation Oncology, University of Toronto, Toronto, ON;; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON
| | - N Laperriere
- Department of Radiation Oncology, University of Toronto, Toronto, ON;; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON
| | - A Bezjak
- Department of Radiation Oncology, University of Toronto, Toronto, ON;; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON
| | - R K S Wong
- Department of Radiation Oncology, University of Toronto, Toronto, ON;; Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON
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14
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Michl M, Thurmaier J, Schubert-Fritschle G, Wiedemann M, Laubender RP, Nüssler NC, Ruppert R, Kleeff J, Schepp W, Reuter C, Löhe F, Karthaus M, Neumann J, Kirchner T, Engel J, Heinemann V. Brain Metastasis in Colorectal Cancer Patients: Survival and Analysis of Prognostic Factors. Clin Colorectal Cancer 2015; 14:281-90. [PMID: 26123495 DOI: 10.1016/j.clcc.2015.05.009] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Revised: 05/25/2015] [Accepted: 05/29/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND The purpose of the study was to characterize the rare cohort of patients (pts) with metastatic colorectal cancer (mCRC) and brain metastasis (BM) and to identify prognostic subgroups. PATIENTS AND METHODS In collaboration with the Munich Cancer Registry, pts with mCRC and BM who were diagnosed between 1998 and 2011 were identified. Survival from the time of first diagnosis of colorectal cancer (CRC) (OS-1), from the time of diagnosis of metastatic disease (OS-2) and of BM (OS-3) was calculated regarding (1) the temporal occurrence of extra- and intracranial metastasis (meta- vs. synchronous) and (2) tumor and patient characteristics. For survival analysis the Kaplan-Meier estimator and Cox regression models were used. RESULTS A total of 228 pts (134 male [59%], 94 female [41%]) were identified. The median age was 63 years (142 pts [62%] were 65 years of age or younger). Most pts presented with primary tumors staged T3/4, N+, Grade 2. The primary tumor was located predominantly in the left colon (155 pts; 68%), especially in the rectum (95 pts; 42%). Median OS-1 was 35.6 months (95% confidence interval [CI], 30.1-41.1 months), OS-2 was 16.5 months (95% CI, 13.9-19.1 months), and OS-3 was 2.0 months (95% CI, 1.5-2.5 months). Median time from first CRC diagnosis to BM was 29.2 months. Subsequent BM after extracranial metastasis were observed in 184 pts (80.7%), whereas 31 pts (13.6%) presented with solitary BM. Univariate analysis did not reveal a prognostic variable for overall survival after diagnosis of BM. CONCLUSION This study presents the largest number of pts with mCRC and BM analyzed to date. The results show that most mCRC pts develop BM as a late step in the course of disease. Median time from first CRC diagnosis to BM is 29.2 months. Only a few pts were diagnosed with BM early in the disease or with solitary BM. When BM is present survival is poor.
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Affiliation(s)
- Marlies Michl
- Department of Hematology and Medical Oncology, Klinikum Grosshadern and Comprehensive Cancer Center Munich (CCCM), Ludwig-Maximilians-University of Munich, Munich, Germany.
| | - Johannes Thurmaier
- Department of Hematology and Medical Oncology, Klinikum Grosshadern and Comprehensive Cancer Center Munich (CCCM), Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Gabriele Schubert-Fritschle
- Munich Cancer Registry (MCR), IBE / Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Max Wiedemann
- Munich Cancer Registry (MCR), IBE / Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Rüdiger P Laubender
- Institute of Medical Informatics, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Natascha C Nüssler
- Department of Surgery, Klinikum Neuperlach, Städtisches Klinikum München, Munich, Germany
| | - Reinhard Ruppert
- Department of Surgery, Klinikum Neuperlach, Städtisches Klinikum München, Munich, Germany
| | - Jörg Kleeff
- Department of Surgery, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany
| | - Wolfgang Schepp
- Department of Gastroenterology, Hepatology and Gastrointestinal Oncology, Klinikum Bogenhausen, Städtisches Klinikum München, Munich, Germany
| | - Clemens Reuter
- Department of Surgery, Krankenhaus Barmherzige Brüder München, Munich, Germany
| | - Florian Löhe
- Department of Surgery, Klinikum Landshut, Landshut, Germany
| | - Meinolf Karthaus
- Department of Hematology, Oncology and Palliative Care, Städtisches Klinikum Harlaching und Neuperlach, Munich, Germany
| | - Jens Neumann
- Institute of Pathology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Thomas Kirchner
- Institute of Pathology, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Jutta Engel
- Munich Cancer Registry (MCR), IBE / Klinikum Grosshadern, Ludwig-Maximilians-University of Munich, Munich, Germany; Institute of Medical Informatics, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Volker Heinemann
- Department of Hematology and Medical Oncology, Klinikum Grosshadern and Comprehensive Cancer Center Munich (CCCM), Ludwig-Maximilians-University of Munich, Munich, Germany
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15
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Fogarty GB, Hong A, Dolven-Jacobsen K, Reisse CH, Burmeister B, Haydu LH, Dhillon H, Steel V, Shivalingam B, Drummond K, Vardy J, Nowak A, Hruby G, Scolyer RA, Mandel C, Thompson JF. First interim analysis of a randomised trial of whole brain radiotherapy in melanoma brain metastases confirms high data quality. BMC Res Notes 2015; 8:192. [PMID: 25952979 PMCID: PMC4428505 DOI: 10.1186/s13104-015-1153-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 04/27/2015] [Indexed: 11/20/2022] Open
Abstract
Background Brain metastases are a common cause of death in patients with melanoma. The role of adjuvant whole brain radiotherapy (WBRT) following local treatment of intracranial melanoma metastases is controversial. The Australian and New Zealand Melanoma Trials Group (ANZMTG) and the Trans-Tasman Radiation Oncology Group (TROG) are leading the first ever single histology randomised trial investigating this question. The primary endpoint is distant intracranial failure on magnetic resonance imaging (MRI) within twelve months of randomisation. The first planned interim analysis was performed twelve months after randomisation of the 100th patient. The analysis was an opportunity to review completeness of the trial data to date. Methods All data received up to the end of twelve months after randomisation of the 100th patient was reviewed. Results Review of pathology reports confirmed that all 100 patients had stage IV melanoma and were appropriately entered into the study. Of the 47 distant intracranial events, 34 occurred in isolation (i.e. only distant failure was identified), whilst 13 were accompanied by local failure. Data review showed compliance with the protocol mandated MRI schedule and accuracy of intracranial failure reporting was very high. The Quality of Life (QoL) component of the study achieved a 91% completion rate. For the neurocognitive function (NCF) assessments, a high completion rate was maintained throughout the 12 month period. Where assessments were not performed at expected time points, valid reasons were noted. Radiotherapy quality was high. Of 50 patients who received WBRT, 32 were reviewed as per protocol design and there was only one major variation out of 308 data points reviewed (0.3%). There were minimal trial related adverse events (AEs) and no serious adverse events (SAEs). Pre-specified protocol stopping rules were not met. Conclusions The Data Safety Monitoring Committee (DSMC) recommended the trial continue recruitment after reviewing the unblinded data. The data provision and quality to date indicates that a reliable outcome will be obtained when the final analysis is performed. Accrual is ongoing with 156 out of 200 patients randomised to date (26th November 2014).
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Affiliation(s)
- Gerald B Fogarty
- Melanoma Institute Australia, Sydney, Australia. .,Department of Radiation Oncology, St Vincent's General Hospital, Sydney, Australia. .,Genesis Cancer Care, Department of Radiation Oncology, Mater Hospital, Sydney, Australia. .,Trans-Tasman Radiation Oncology Group (TROG), Newcastle, Australia. .,Australia and New Zealand Melanoma Trials Group (ANZMTG), North Sydney, Australia.
| | - Angela Hong
- Melanoma Institute Australia, Sydney, Australia. .,Trans-Tasman Radiation Oncology Group (TROG), Newcastle, Australia. .,Sydney Medical School,
- The University of Sydney, Sydney, Australia.
| | | | - Claudius H Reisse
- Oslo University Hospital HF, The Norwegian Radium Hospital, Oslo, Norway.
| | - Bryan Burmeister
- Trans-Tasman Radiation Oncology Group (TROG), Newcastle, Australia. .,Princess Alexandra Hospital, Brisbane, Australia. .,Australia and New Zealand Melanoma Trials Group (ANZMTG), North Sydney, Australia.
| | | | - Haryana Dhillon
- Centre for Medical Psychology & Evidence-based Decision-making, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia. .,Psycho-Oncology Co-Operative Research Group (PoCoG), School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia.
| | - Victoria Steel
- Australia and New Zealand Melanoma Trials Group (ANZMTG), North Sydney, Australia.
| | | | - Kate Drummond
- The Royal Melbourne Hospital & University of Melbourne, Parkville, Australia.
| | - Janette Vardy
- Sydney Medical School,
- The University of Sydney, Sydney, Australia. .,Centre for Medical Psychology & Evidence-based Decision-making, Sydney Medical School, The University of Sydney, Camperdown, NSW, Australia. .,Psycho-Oncology Co-Operative Research Group (PoCoG), School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia. .,Concord Repatriation and General Hospital, Concord, Australia.
| | - Anna Nowak
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Australia. .,Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Australia.
| | - George Hruby
- Sydney Medical School,
- The University of Sydney, Sydney, Australia. .,Royal Prince Alfred Hospital, Sydney, Australia. .,Australia and New Zealand Melanoma Trials Group (ANZMTG), North Sydney, Australia.
| | - Richard A Scolyer
- Melanoma Institute Australia, Sydney, Australia. .,Sydney Medical School,
- The University of Sydney, Sydney, Australia. .,Royal Prince Alfred Hospital, Sydney, Australia.
| | - Catherine Mandel
- Peter MacCallum Cancer Centre East Melbourne & University of Melbourne, Parkville, Australia.
| | - John F Thompson
- Melanoma Institute Australia, Sydney, Australia. .,Sydney Medical School,
- The University of Sydney, Sydney, Australia. .,Royal Prince Alfred Hospital, Sydney, Australia. .,Australia and New Zealand Melanoma Trials Group (ANZMTG), North Sydney, Australia.
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16
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Phungrassami T, Sriplung H. Radiotherapy for brain metastases in southern Thailand: workload, treatment pattern and survival. Asian Pac J Cancer Prev 2015; 16:1435-42. [PMID: 25743812 DOI: 10.7314/apjcp.2015.16.4.1435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To study the patient load, treatment pattern, survival outcome and its predictors in patients with brain metastases treated by radiotherapy. MATERIALS AND METHODS Data for patients with brain metastases treated by radiotherapy between 2003 and 2007 were collected from medical records, the hospital information system database, and a population-based tumor registry database until death or at least 5 years after treatment and retrospectively reviewed. RESULTS The number of treatments for brain metastases gradually increased from 48 in 2003 to 107 in 2007, with more than 70% from lung and breast cancers. The majority were treated with whole brain radiation of 30 Gy (3 Gy X 10 fractions) by cobalt-60 machine, using radiation alone. The overall median survival of the 418 patients was 3.9 months. Cohort analysis of relative survival after radiotherapy was as follows: 52% at 3 months, 18% at 1 year and 3% at 5 years in males; and 66% at 3 months, 26% at 1 year and 7% at 5 years in females. Multivariate analysis demonstrated that the patients treated with combined modalities had a better prognosis. Poor prognostic factors included primary cancer from the lung or gastrointestinal tract, emergency or urgent consultation, poor performance status (ECOG 3-4), and a hemoglobin level before treatment of less than 10 g/dl. CONCLUSIONS This study identified an increasing trend of patient load with brain metastases. Possible over-treatment and under-treatment were demonstrated with a wide range of survival results. Practical prognostic scoring systems to assist in decision-making for optimal treatment of different patient groups is absolutely necessary; it is a key strategy for balancing good quality of care and patient load.
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Affiliation(s)
- Temsak Phungrassami
- Division of Therapeutic Radiology and Oncology, Songklanagarind Hospital, Songkhla, Thailand E-mail :
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17
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Fogarty GB, Hong A, Jacobsen KD, Reisse CH, Shivalingam B, Burmeister B, Haydu LE, Paton E, Thompson JF. Accrual to a randomised trial of adjuvant whole brain radiotherapy for treatment of melanoma brain metastases is feasible. BMC Res Notes 2014; 7:412. [PMID: 24981506 PMCID: PMC4083364 DOI: 10.1186/1756-0500-7-412] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 06/20/2014] [Indexed: 11/13/2022] Open
Abstract
Background Brain metastases (BMs) are common in melanoma patients. Adjuvant whole brain radiotherapy (WBRT) following local treatment of intracranial melanoma metastases with neurosurgery and/or stereotactic radiosurgery is controversial. A randomised trial is needed. However, accrual to WBRT trials has been problematic. A pilot study by Australia and New Zealand Melanoma Trials Group (ANZMTG) was conducted to see if accrual was feasible. Methods Sites canvassed for interest included those who treat melanoma patients, had a proven accrual in previous melanoma trials and who had the relevant infrastructure support. Feasibility forecasts from interested sites were sought. These were compared to the patient numbers documented in the research contracts. A target accrual of 60 patients in 2 years was set. Funding was sought for the pilot study. Basic demographics of the pilot study cohort were collected. Results The first centre opened December 2008; the first patient was randomised in April 2009. The pilot accruing period concluded in September, 2011. In 30 months, 54 patients from 10 of a total of 17 activated sites in Australia (39, 72%) and in Norway (15, 28%) had been accrued. Feasibility forecasts predicted 133 trial eligible patients per year (including 108 Australian + 25 International patients). Site estimates generally overestimated accrual with 4 of 17 active sites estimating within 50% of target numbers. Sites with patient estimates calculated from records were more accurate than those estimated from memory. The overall recruitment target was lower in the research contracts when compared to the feasibility evaluation. Basic demographics of the pilot study revealed 62% of patients were males; 58% had a single metastasis, 28% had two and 14% had three metastases. 12-month overall survival was 50%. Conclusions Despite only 54 patients and not the full 60 patient target being accrued in two years the Trial Management Committee and Data Safely Monitoring Committee approved the continuation of the pilot study to the main trial. On the basis of this successful pilot study, funding was achieved for the full study. 143 patients of a target of 200 have been randomised by June 2014.
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18
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Jeremic B, Vanderpuye V, Abdel-Wahab S, Gaye P, Kochbati L, Diwani M, Emwula P, Oro B, Lishimpi K, Kigula-Mugambe J, Dawotola D, Wondemagegnehu T, Nyongesa C, Oumar N, El-Omrani A, Shuman T, Langenhoven L, Fourie L. Patterns of Practice in Palliative Radiotherapy in Africa – Case Revisited. Clin Oncol (R Coll Radiol) 2014; 26:333-43. [DOI: 10.1016/j.clon.2014.03.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 02/14/2014] [Accepted: 03/11/2014] [Indexed: 12/25/2022]
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19
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Akhavan A, Binesh F, Heidari S. Survival of brain metastatic patients in Yazd, Iran. Asian Pac J Cancer Prev 2014; 15:3571-4. [PMID: 24870759 DOI: 10.7314/apjcp.2014.15.8.3571] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Brain metastasis occurs when cancerous cells come from a known (or sometimes an unknown) primary tumor to the brain and implant and grow there. This event is potentially lethal and causes neurologic symptoms and signs. These patients are treated in order to decrease their neurologic problems, increase quality of life and overall survival. MATERIALS AND METHODS In this study we evaluated clinical characteristics of 206 patients with brain metastases referred to our center from 2004 to 2011. RESULTS The mean age was 53.6 years. The primary tumors were breast cancer (32%), lung cancer (24.8%), lymphoma (4.4%), sarcoma (3.9%), melanoma (2.9%), colorectal cancer (2.4%) and renal cell carcinoma (1.5%). In 16.5% of the patients, brain metastasis was the first presenting symptom and the primary site was unknown. Forty two (20.4%) patients had a single brain metastasis, 18 patients (8.7%) had two or three lesions, 87 (42.2%) patients had more than three lesions. Leptomeningeal involvement was seen in 49 (23.8%) patients. Thirty five (17%) had undergone surgical resection. Whole brain radiation therapy was performed for all of the patients. Overall survival was 10.1 months (95%CI; 8.65-11.63). One and two year survival was 27% and 12% respectively. CONCLUSIONS Overall survival of patients who were treated by combination of surgery and whole brain radiation therapy was significantly better than those who were treated with whole brain radiation therapy only [13.8 vs 9.3 months (p=0.03)]. Age, sex, primary site and the number of brain lesions did not show significant relationships with overall survival.
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Affiliation(s)
- Ali Akhavan
- Department Of Radiotherapy, Isfahan University Of Medical Sciences, Isfahan, Iran E-mail :
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20
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Nieder C, Marienhagen K, Dalhaug A, Aandahl G, Haukland E, Pawinski A. Prognostic models predicting survival of patients with brain metastases: integration of lactate dehydrogenase, albumin and extracranial organ involvement. Clin Oncol (R Coll Radiol) 2014; 26:447-52. [PMID: 24702741 DOI: 10.1016/j.clon.2014.03.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 02/17/2014] [Accepted: 02/18/2014] [Indexed: 11/28/2022]
Abstract
AIMS To explore the role of expanded assessment of metastatic extracranial organ involvement, as well as albumin and lactate dehydrogenase (LDH), i.e. surrogates of disease extent, in survival prediction models for patients with brain metastases. MATERIALS AND METHODS A retrospective analysis of 189 patients treated with whole brain radiotherapy was carried out. Uni- and multivariate analyses included recursive partitioning analysis classes, basic score for brain metastases and diagnosis-specific graded prognostic assessment (DS-GPA). RESULTS Elevated LDH correlated significantly with extracranial organ involvement, low albumin with primary tumour type and primary tumour control. Elevated LDH, low albumin and a combination of both correlated significantly with overall survival. LDH, albumin and the number of extracranial organs involved (none, one, two or more harbouring metastases) were independent prognostic factors in multivariate analyses (if added to the three established scores mentioned above and also if added to individual parameters such as age, performance status, etc.). A combination of these three new prognostic factors predicted very short survival (median 0.7 months if all three were present). CONCLUSION We have previously defined patient groups in whom foregoing radiotherapy was unlikely to compromise survival. These were patients with a DS-GPA score of 0-1.5 points and age ≥75 years or Karnofsky performance status ≤50 or uncontrolled primary tumour with extracranial metastases to at least two organs. Patients with a combination of three new adverse features (elevated LDH plus low albumin plus extracranial metastases to at least two organs) might also be considered for best supportive care. Furthermore, it appears warranted to study whether scores such as DS-GPA can be optimised by integrating information on these three parameters.
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Affiliation(s)
- C Nieder
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway; Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway.
| | - K Marienhagen
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
| | - A Dalhaug
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway; Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - G Aandahl
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway
| | - E Haukland
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway
| | - A Pawinski
- Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway
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21
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Cai Y, Wang JY, Liu H. Clinical Observation of Whole Brain Radiotherapy Concomitant with Targeted Therapy for Brain Metastasis in Non-small Cell Lung Cancer Patients with Chemotherapy Failure. Asian Pac J Cancer Prev 2013; 14:5699-703. [DOI: 10.7314/apjcp.2013.14.10.5699] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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