1
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Ryu WK, Cha HK, Kim W, Lee HY, Kim HJ, Ryu JS, Lim JH. Effect of whole-brain radiotherapy with platinum-based chemotherapy in non-small cell lung cancer patients with multiple metastases including brain metastases. Sci Rep 2023; 13:13173. [PMID: 37580499 PMCID: PMC10425457 DOI: 10.1038/s41598-023-40235-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 08/07/2023] [Indexed: 08/16/2023] Open
Abstract
Current guidelines recommend that cytotoxic chemotherapy be considered first in non-small cell lung cancer (NSCLC) patients with multiple metastases, and whole-brain radiotherapy (WBRT) is not initially recommended even if brain metastases are present. However, cytotoxic chemotherapeutic agents are less effective in brain metastases due to poor blood-brain barrier permeability. We investigated the effect of WBRT in combination with cytotoxic chemotherapy on survival in NSCLC patients who were EGFR, ALK, and PD-L1 negative, had an ECOG PS of 2, and had multiple metastases including brain metastases. From January 2005 to December 2018, histologically confirmed NSCLC patients who were EGFR, ALK, and PD-L1 negative, had an ECOG PS of 2, and had multiple metastases including brain metastases were included in this study. Patients were classified into two groups based on receiving WBRT prior to or concurrently with administration of first-line chemotherapeutic agents or receiving chemotherapy only. We compared intracranial progression-free survival (iPFS) and overall survival (OS). Of the 240 NSCLC patients with brain metastases at diagnosis and an ECOG PS of 2, 67 patients were EGFR, ALK, and PD-L1 negative with multiple metastases including brain metastases. Among those patients, 43 (64.2%) received WBRT prior to or concurrently with platinum-based chemotherapy. Patients who received WBRT prior to or concurrently with chemotherapy had better iPFS (7.7 months [4.8-10.6] vs. 3.5 months [2.1-4.9], p = 0.009) and OS (10.8 months [5.9-15.7] vs. 6.1 months [1.9-10.3], p = 0.038) than those who did not receive WBRT. In multivariate analyses, WBRT was significantly associated with iPFS (HR: 1.94 and 95% CI 1.11-3.40, p = 0.020) and OS (HR: 1.92 and 95% CI 1.08-3.42, p = 0.027). In NSCLC patients who are EGFR, ALK, and PD-L1 negative, have an ECOG PS of 2, and have multiple metastases including brain metastases, WBRT prior to or concurrently with chemotherapy could improve iPFS and OS. Therefore, the combination of WBRT with cytotoxic chemotherapy should be considered in these patients.
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Affiliation(s)
- Woo Kyung Ryu
- Center for Lung Cancer, Division of Pulmonology, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, 27, Inhang-Ro, Jung-Gu, Inchon, 22332, Republic of Korea
| | - Hyung Keun Cha
- Center for Lung Cancer, Division of Pulmonology, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, 27, Inhang-Ro, Jung-Gu, Inchon, 22332, Republic of Korea
| | - Woochul Kim
- Department of Radiation Oncology, Inha University Hospital, Inha University College of Medicine, Inchon, Republic of Korea
| | - Ha Young Lee
- Department of Radiology, Inha University Hospital, Inha University College of Medicine, Inchon, Republic of Korea
| | - Hyun-Jung Kim
- Center for Lung Cancer, Division of Pulmonology, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, 27, Inhang-Ro, Jung-Gu, Inchon, 22332, Republic of Korea
| | - Jeong-Seon Ryu
- Center for Lung Cancer, Division of Pulmonology, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, 27, Inhang-Ro, Jung-Gu, Inchon, 22332, Republic of Korea.
| | - Jun Hyeok Lim
- Center for Lung Cancer, Division of Pulmonology, Department of Internal Medicine, Inha University Hospital, Inha University College of Medicine, 27, Inhang-Ro, Jung-Gu, Inchon, 22332, Republic of Korea.
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2
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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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3
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Sas-Korczynska B, Rucinska M. WBRT for brain metastases from non-small cell lung cancer: for whom and when?-Contemporary point of view. J Thorac Dis 2021; 13:3246-3257. [PMID: 34164217 PMCID: PMC8182552 DOI: 10.21037/jtd-2019-rbmlc-06] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The incidence of brain metastases (BM) is estimated between 20% and 40% of patients with solid cancer. The most common cause of this failure is lung cancer, and in locally advanced non-small cell lung cancer (NSCLC) BM represent a common site of relapse in 30-55% cases. The basic criteria of therapeutic decision-making are based on the significant prognostic factors which are components of prognostic scores. The standard approach to treatment of BM from NSCLC include whole brain radiotherapy (WBRT) which is used as adjuvant modality after local therapy (surgery or stereotactic radiosurgery) or as primary treatment and it remains the primary modality of treatment for patients with multiple metastases. WBRT is also used in combination with systemic therapy. The aim of presented review of literature is trying to answer which patients with BM from NSCLC should receive WBRT and when it could be omitted. There were presented the aspects of application of WBRT in relation to (I) choice between WBRT or the best supportive care and (II) employment of WBRT in combination with local treatment modalities [surgical resection or stereotactic radio-surgery (SRS)] and/or with systemic therapy. According to data from literature we concluded that the most important factor that needs to be considered when assessing the suitability of a patient for WBRT is the patient's prognosis based on the Lung-molGPA score. WBRT should be applied in treatment of multiple BM from lung cancer in patients with favourable prognosis and in in patients with presence of EML4-ALK translocation before therapy with crizotinib. Whereas WBRT could be omitted in patients with poor prognosis and after primary SRS.
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Affiliation(s)
- Beata Sas-Korczynska
- Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland.,Department of Radiotherapy, Military Institute of Medicine, Warsaw, Poland
| | - Monika Rucinska
- Department of Radiotherapy, Military Institute of Medicine, Warsaw, Poland.,Department of Oncology, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
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4
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Liu Y, Wang J, Wu J, Yang Q, Zeng Y, Wu D, Tian C, Hu Y, Gu F, Li C, Zhang K, Liu L. The Efficacy of First-Generation EGFR-TKI Combined With Brain Radiotherapy as the First-Line Treatment for Lung Adenocarcinoma Patients With Brain Metastases and EGFR Sensitive Mutations: A Retrospective study. Technol Cancer Res Treat 2021; 20:1533033821997819. [PMID: 33715525 PMCID: PMC7958186 DOI: 10.1177/1533033821997819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: It was controversial that whether LUAD patients with brain metastases (BMs)
and EGFR sensitive mutations should be conducted using brain radiotherapy
when treated with first-generation EGFR-TKI. Herein, a retrospective study
was designed to compare the efficacy of first-generation EGFR-TKI combined
with brain radiotherapy and EGFR-TKI alone as first-line treatment for these
LUAD patients. Patients and Methods: We retrospectively analyzed the status of patients with advanced LUAD
carrying EGFR sensitive mutations who received first-generation EGFR-TKI
treatment in our center. iPFS was the first time of intracranial progression
or death from the diagnosis of BMs, PFS was the time of progression of any
site or death from the diagnosis of BMs, and OS was the time of confirmed
BMs to death or the last follow-up time. Differences in characteristics
between groups were compared using the Chi-square test. The Kaplan-Meier
method was used to calculate the iPFS, PFS, and OS. Univariate analysis,
multivariate analysis, and subgroup analysis were conducted by Cox
regression model. Results: There were 77 patients (77/134, 57.5%) in the TKI + RT group and 57 patients
(57/134, 42.5%) in the TKI group. TKI + RT group had a significant higher
intracranial ORR and DCR, and the combination therapy was independently
significantly associated with a longer iPFS (18.9 vs. 10.5
months, P = 0.0009), systematic PFS (12.5
vs. 8.4 months, P = 0.0071) and OS
(30.8 vs. 22.7 months, P = 0.0183).
Females, non-smokers, and younger patients benefited more from the
combination therapy. Subgroup analysis demonstrated that the combination
therapy could improve the iPFS in patients with more than 3 BMs
(P = 0.005); however, it couldn’t improve the OS for
these patients. Conclusion: Our study confirmed the effect of the combination of EGFR-TKI and brain
radiotherapy as first-line treatment for LUAD patients with BMs and EGFR
sensitive mutations.
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Affiliation(s)
- Yuting Liu
- Cancer Center, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Juanjuan Wang
- Cancer Center, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Jingjing Wu
- Cancer Center, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Qifan Yang
- Cancer Center, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Yulan Zeng
- Cancer Center, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Di Wu
- Cancer Center, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Chen Tian
- Cancer Center, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Yue Hu
- Cancer Center, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Feifei Gu
- Cancer Center, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Chang Li
- Cancer Center, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Kai Zhang
- Cancer Center, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
| | - Li Liu
- Cancer Center, Union Hospital, Tongji Medical College, 12443Huazhong University of Science and Technology, Wuhan, China
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5
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Ni M, Liu W, Jiang A, Wang Y, Sheng Y, Zeng H, Liu N, Li L, Qi Y, Wang Y, Yu J, Yuan S. Whole Brain Radiation Therapy Plus Focal Radiation Boost May Generate Better Survival Benefit for Brain Metastases From Non-small Cell Lung Cancer. Front Oncol 2020; 10:576700. [PMID: 33194690 PMCID: PMC7606935 DOI: 10.3389/fonc.2020.576700] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/28/2020] [Indexed: 12/25/2022] Open
Abstract
Background Owing to improved systemic therapies, the survival of patients with non-small cell lung cancer (NSCLC) was prolonged, and the risk of brain metastases was consequently increased. This study aims to compare different radiotherapy for brain metastases in patients with NSCLC. Materials and methods The patients with NSCLC who were treated with whole brain radiation therapy (WBRT) or stereotactic radiosurgery (SRS) for brain metastases at three medical centers between January 2012 and December 2017 were retrospectively analyzed. Results Of the 684 eligible patients, 217 received WBRT plus focal radiation boost (WBRT+boost), 324 received WBRT, and 143 received SRS. Patients with WBRT+boost lived longer than those with WBRT (median overall survival (OS), 22.2 vs 13.7 months, P < 0.001) or SRS (22.2 vs 17.3 months, P = 0.011). In subgroup analyses, the survival advantage of WBRT+boost was more obvious among patients with 1 to 3 brain metastases or who received targeted therapy than did SRS. From pair-wise comparisons of intracranial progression-free survival (iPFS), WBRT+boost was also superior to WBRT (12.9 vs 10.6 months, P = 0.028) and SRS (12.9 vs 9.1 months, P = 0.001). Conclusions Patients who were treated with WBRT+boost experienced significantly longer OS and iPFS than those with WBRT or SRS alone. WBRT+boost should be a preferred strategy for brain metastases in NSCLC patients.
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Affiliation(s)
- Meng Ni
- Department of Radiation Oncology, Qingdao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Wenju Liu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Aijun Jiang
- Department of Radiation Oncology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yong Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yanxing Sheng
- Department of Radiation Oncology, Liaocheng People's Hospital, Liaocheng, China
| | - Haiyan Zeng
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Ning Liu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Li Li
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Yiqiang Qi
- Department of Radiation Oncology, ZiBo Central Hospital, Zibo, China
| | - Yu Wang
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Jinming Yu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Shuanghu Yuan
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.,Department of Radiation Oncology, Shandong Cancer Hospital and Institute-Shandong Cancer Hospital Affiliated to Shandong University, Jinan, China
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6
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Bilous M, Serdjebi C, Boyer A, Tomasini P, Pouypoudat C, Barbolosi D, Barlesi F, Chomy F, Benzekry S. Quantitative mathematical modeling of clinical brain metastasis dynamics in non-small cell lung cancer. Sci Rep 2019; 9:13018. [PMID: 31506498 PMCID: PMC6736889 DOI: 10.1038/s41598-019-49407-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 08/23/2019] [Indexed: 12/25/2022] Open
Abstract
Brain metastases (BMs) are associated with poor prognosis in non-small cell lung cancer (NSCLC), but are only visible when large enough. Therapeutic decisions such as whole brain radiation therapy would benefit from patient-specific predictions of radiologically undetectable BMs. Here, we propose a mathematical modeling approach and use it to analyze clinical data of BM from NSCLC. Primary tumor growth was best described by a gompertzian model for the pre-diagnosis history, followed by a tumor growth inhibition model during treatment. Growth parameters were estimated only from the size at diagnosis and histology, but predicted plausible individual estimates of the tumor age (2.1-5.3 years). Multiple metastatic models were further assessed from fitting either literature data of BM probability (n = 183 patients) or longitudinal measurements of visible BMs in two patients. Among the tested models, the one featuring dormancy was best able to describe the data. It predicted latency phases of 4.4-5.7 months and onset of BMs 14-19 months before diagnosis. This quantitative model paves the way for a computational tool of potential help during therapeutic management.
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Affiliation(s)
- M Bilous
- MONC team, Inria Bordeaux Sud-Ouest, Talence, France
- Institut de Mathématiques de Bordeaux, Bordeaux University, Talence, France
| | - C Serdjebi
- SMARTc Unit, Center for Research on Cancer of Marseille (CRCM), Inserm UMR 1068, CNRS UMR 7258, Aix-Marseille University U105, Marseille, France
| | - A Boyer
- SMARTc Unit, Center for Research on Cancer of Marseille (CRCM), Inserm UMR 1068, CNRS UMR 7258, Aix-Marseille University U105, Marseille, France
- Multidisciplinary Oncology and Therapeutic Innovations Department and CRCM, Inserm UMR 1068, CNRS UMR 7258, Assistance Publique Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - P Tomasini
- Multidisciplinary Oncology and Therapeutic Innovations Department and CRCM, Inserm UMR 1068, CNRS UMR 7258, Assistance Publique Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - C Pouypoudat
- Radiation oncology department, Haut-Lévêque Hospital, Pessac, France
| | - D Barbolosi
- SMARTc Unit, Center for Research on Cancer of Marseille (CRCM), Inserm UMR 1068, CNRS UMR 7258, Aix-Marseille University U105, Marseille, France
| | - F Barlesi
- SMARTc Unit, Center for Research on Cancer of Marseille (CRCM), Inserm UMR 1068, CNRS UMR 7258, Aix-Marseille University U105, Marseille, France
- Multidisciplinary Oncology and Therapeutic Innovations Department and CRCM, Inserm UMR 1068, CNRS UMR 7258, Assistance Publique Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - F Chomy
- Clinical oncology department, Institut Bergonié, Bordeaux, France
| | - S Benzekry
- MONC team, Inria Bordeaux Sud-Ouest, Talence, France.
- Institut de Mathématiques de Bordeaux, Bordeaux University, Talence, France.
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7
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Ponce S, Bruna J, Juan O, López R, Navarro A, Ortega AL, Puente J, Verger E, Bartolomé A, Nadal E. Multidisciplinary expert opinion on the treatment consensus for patients with EGFR mutated NSCLC with brain metastases. Crit Rev Oncol Hematol 2019; 138:190-206. [PMID: 31092376 DOI: 10.1016/j.critrevonc.2019.03.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 02/09/2019] [Accepted: 03/26/2019] [Indexed: 12/14/2022] Open
Abstract
The presence of an epidermal growth factor receptor (EGFR) mutation is associated with higher incidence of brain metastases in patients with non-small cell lung cancer (NSCLC); however, patients with synchronous brain metastases at diagnosis have generally been excluded from clinical trials. As there is limited clinical evidence for managing this patient population, a multidisciplinary group of Spanish medical and radiation oncologists, and neuro-oncologist with expertise treating brain metastases in lung cancer patients met with the aim of reaching and developing an expert opinion consensus on the management of patients with EGFR mutated NSCLC with brain metastases. This consensus contains 26 recommendations and 20 conclusion statements across 21 questions in 7 areas, as well as a first-line treatment algorithm.
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Affiliation(s)
- Santiago Ponce
- Lung Cancer Clinical Research Unit, Hospital Universitario 12 de Octubre, Av. Cordoba, s/n, 28041 Madrid, Spain.
| | - Jordi Bruna
- Neuro-Oncology Unit, Bellvitge University Hospital-ICO, Carrer de la Feixa Llarga, s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain; Clinical Research in Solid Tumors (CReST) and Neuro-Oncology Group. Oncobell, IDIBELL, Avda Gran Via 199-203, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Oscar Juan
- Medical Oncology Service, Hospital Universitario y Politécnico La Fe, Valencia, Avda. de Fernando Abril Martorell, nº 106, 46026, Valencia, Spain.
| | - Rafael López
- Medical Oncology Unit. Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 3, 47003, Valladolid, Spain.
| | - Alejandro Navarro
- Medical Oncology. Hospital Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain.
| | - Ana Laura Ortega
- Oncology Research Unit, Complejo Hospitalario de Jaén, Av. del Ejército Español, 10, 23007, Jaén, Spain.
| | - Javier Puente
- GU, Thoracic and Melanoma Cancer Unit, Medical Oncology Department, Assistant Professor of Medicine, Complutense University. Hospital Clinico Universitario San Carlos, Calle del Prof Martín Lagos, s/n, 28040, Madrid, Spain.
| | - Eugènia Verger
- Radiation Oncology Department, Hospital Clínic de Barcelona, Carrer de Villarroel, 170, 08036, Barcelona, Spain.
| | - Adela Bartolomé
- Radiotherapy Oncology Department. Hospital Universitario 12 de Octubre, Av. Cordoba, s/n, 28041, Madrid, Spain.
| | - Ernest Nadal
- Clinical Research in Solid Tumors (CReST) and Neuro-Oncology Group. Oncobell, IDIBELL, Avda Gran Via 199-203, 08907, L'Hospitalet de Llobregat, Barcelona, Spain; Thoracic Oncology Unit, Department of Medical Oncology, Catalan Institute of Oncology. Avda Gran Via 199-203, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
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8
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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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9
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Loganadane G, Hendriks L, Le Péchoux C, Levy A. The Current Role of Whole Brain Radiation Therapy in Non-Small Cell Lung Cancer Patients. J Thorac Oncol 2017; 12:1467-1477. [PMID: 28733269 DOI: 10.1016/j.jtho.2017.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/19/2017] [Accepted: 07/07/2017] [Indexed: 10/19/2022]
Abstract
The incidence of brain metastases has increased in patients with NSCLC as a result of better systemic disease control and advances in imaging modalities. Whole brain radiotherapy (WBRT) has been the mainstay treatment of multiple symptomatic brain metastases for years. A number of recent publications have questioned its place in the absence of a survival and quality of life benefit and the possible risk for long-term neurotoxicity. Omission or deferral of WBRT and strategies consisting of stereotactic radiosurgery or delivery of systemic therapies alone are being proposed more and more. However, critical analysis of the literature shows that WBRT still has relevant indications in well-selected patients. Within this review, we discuss the place of WBRT in the modern management of patients with NSCLC.
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Affiliation(s)
- Gokoulakrichenane Loganadane
- Assistance Publique-Hôpitaux de Paris, Department of Radiation Oncology, CHU Henri Mondor, University of Paris-Est, Créteil, France
| | - Lizza Hendriks
- Department of Pulmonary Diseases, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Cécile Le Péchoux
- Department of Radiation Oncology, Gustave Roussy, Institut d'Oncologie Thoracique, Université Paris-Saclay, Villejuif, France
| | - Antonin Levy
- Department of Radiation Oncology, Gustave Roussy, Institut d'Oncologie Thoracique, Université Paris-Saclay, Villejuif, France; INSERM U1030, Molecular Radiotherapy, Gustave Roussy, Université Paris-Saclay, Villejuif, France; Univ Paris Sud, Université Paris-Saclay, Le Kremlin-Bicêtre, France.
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