Analysis of prognostic factors in patients with brain metastases affecting survival

Abstract

Introduction Brain metastases (BM) are associated with dismal prognosis as they cause significant morbidity and affect the quality of life of patients. Management of BM depends on the following factors: age, patient performance, size and the number of lesions, location of the tumor, comorbidities, primary tumor type, and extracranial disease burden. In the present study, the pattern of occurrence, clinical characteristics, treatment outcome of brain metastases, and factors, tumor characteristics, and treatment that may impact BM patients’ overall survival were analyzed. Methods Retrospective analysis of medical records of 116 patients with histologically proven primary site solid tumors with brain metastases was done in the present study. Clinicoradiological and pathological parameters were documented. The relationship between variables and outcome was assessed by univariate analysis using the Cox proportional regression model to reach a significance of p < 0.05, to determine independent predictors of overall survival. Results One hundred sixteen patients of BM from various solid malignancies were included. Age ranged from 18 to 81 years (median 53.5). One hundred four patients received WBRT with a dose range of 8–40Gy/1–15fr, 7 received SRS with a dose of 18–24Gy depending on the size of the metastatic lesion, and 2 received SRT 27–33Gy/3fr. At the time of final analysis, 47 patients with BM had expired, 60 were lost to follow-up, and 9 were alive. Median survival was 8.25 (0.5–32.5 months) months. Female gender (χ2 = 8.423; p = 0.015), RPA I (χ2 = 9.353; p = 0.05), and metachronous BM (χ2 = 3.793; p = 0.03) were associated with better survival. Patients with age 41–50 years, adenocarcinoma lung histology, and supratentorial location survived more than 2 years but did not show any statistical significance. Conclusion Brain metastases portend a very dismal prognosis. Certain clinicoradiological and pathologic factors have been identified to affect survival. More prospective multicentric trials, with a larger sample size, need to be conducted to assess the benefit of radiation in patients with limited life expectancy and identify prognostic and predictive factors for survival.

Factors Affecting 2-Year Survival in Patients With Non–Small Cell Lung Cancer Brain Metastases: Evidence from Indonesia’s National Cancer Center, Jakarta, Indonesia

“…This result was supported by the Kaplan-Meier curves (Figure 1). The results of a study by Gupta et al 14 in which 70% of the patients had lung cancer showed that female sex was a factor affecting the overall survival of patients with BM. Patients with NSCLC that led to the development of BM had a higher frequency of EGFR mutations than patients without BM; conversely, among patients with NSCLC and EGFR mutations, the incidence of BM (70%) was higher than that in patients with NSCLC and wild-type EGFR (38%).…”

Synthetic analogues of podophillotoxin and their antimitotic activities

“…Podophyllotoxin, its derivatives and analogues finds a lot of scopes in pharmaceutical field as it show wide biological activities. Several researchres worked on the analogues of podophyllotoxin and its derivatives for variety of biological activities such as cathartic, cytotoxic, antimitotic, anticancer, antitropical skin disease, antimalarial, virucidal, fungicidal [5][6][7][8][9][10][11][12][13][14][15][16][17][18] . In the present work the analogues of podophyllotoxin 6, 6adihydro-2, 3-dimethoxy-9-methyl-11bH benzo [c] fluoren -5, 7 dione and 6, 6a-dihydro-3-methoxy-2, 9-dimethyl-11bH benzo [c] fluoren -5, 7 dione.…”

“…The sandoz company in Basel (Switzerland) have developed a number of semi synthetic derivatives mainly glycosides that have retained the desirable antimitotic activity and lost the undesired side effects. At least four of these VIZ: SP-1 and SP-G, VM-26 (tenoposide) and VP-16-213 (etoposide) are now in clinical use [14][15][16][17][18] .…”

Prognostic factors in postoperative brain metastases derive from non-small cell lung cancer：a retrospective analysis

“…We observed that patients with adenocarcinoma generally have a longer OS compared to other types, while those with tumors that are di cult to accurately categorize under the microscope have the poorest prognosis. One year ago, in a study on BMs conducted by Gupta, it was similarly observed that patients aged 41-50 years and with an adenocarcinoma histological subtype experienced a longer survival period [12]. GPA, as a commonly used scoring system for assessing the prognosis of intracranial tumor patients, is primarily employed to predict the survival period of these patients.…”