Diagnosis-Specific Prognostic Factors, Indexes, and Treatment Outcomes for Patients With Newly Diagnosed Brain Metastases: A Multi-Institutional Analysis of 4,259 Patients

Sperduto, Paul W.; Chao, Samuel T.; Sneed, Penny K.; Luo, Xianghua; Suh, John H.; Roberge, David; Bhatt, Amit; Jensen, Ashley W.; Brown, Paul D.; Shih, Helen A.; Kirkpatrick, John P.; Schwer, Amanda; Gaspar, Laurie E.; Fiveash, John B.; Chiang, Veronica; Knisely, Jonathan; Sperduto, Christina Maria; Mehta, Minesh P.

doi:10.1016/j.ijrobp.2009.08.025

Cited by 884 publications

(763 citation statements)

References 32 publications

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“…In a study of 4295 patients with brain metastases from renal cell carcinoma, Karnofsky performance status and number of brain metastases were identifi ed as signifi cant prognostic factors. 67 Patients with a Karnofsky performance status of 90-100 and one brain lesion had a median overall survival of 14·8 months (95% CI 12·9-17·1) versus 3·3 months (3·0-3·8) for those with a Karnofsky performance status less than 70 and more than three metastases. Present data suggest that WBRT is adequate for patients with poor performance who need palliative treatment for multiple lesions.…”

Section: Discussionmentioning

confidence: 96%

Local treatments for metastases of renal cell carcinoma: a systematic review

Dabestani

Marconi

Hofmann

et al. 2014

The Lancet Oncology

287

205

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Local treatment of metastases such as metastasectomy or radiotherapy remains controversial in the treatment of metastatic renal cell carcinoma. To investigate the benefi ts and harms of various local treatments, we did a systematic review of all types of comparative studies on local treatment of metastases from renal cell carcinoma in any organ. Interventions included metastasectomy, radiotherapy modalities, and no local treatment. The results suggest that patients treated with complete metastasectomy have better survival and symptom control (including pain relief in bone metastases) than those treated with either incomplete or no metastasectomy. Nevertheless, the available evidence was marred by high risks of bias and confounding across all studies. Although the fi ndings presented here should be interpreted with caution, they and the identifi ed gaps in knowledge should provide guidance for clinicians and researchers, and directions for further research.

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Section: Discussionmentioning

confidence: 96%

Local treatments for metastases of renal cell carcinoma: a systematic review

Dabestani

Marconi

Hofmann

et al. 2014

The Lancet Oncology

287

205

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“…10,[36][37][38] The Graded Prognostic Assessment has recently been shown to also predict survival in the salvage SRS setting. 39 Variables, such as patient age, KPS, cancer histology, number of metastases, and systemic disease status, which predict for regional brain failure and WBRT-free survival after initial SRS, are also likely useful in the context of salvage treatments.…”

Section: Discussionmentioning

confidence: 99%

Management Approach for Recurrent Brain Metastases Following Upfront Radiosurgery May Affect Risk of Subsequent Radiation Necrosis

Rae

Gorovets

Rava

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

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Purpose: Many patients treated with stereotactic radiosurgery (SRS) alone as initial treatment require 1 or more subsequent salvage therapies. This study aimed to determine if commonly used salvage strategies are associated with differing risks of radiation necrosis (RN). Methods and materials: All patients treated with upfront SRS alone for brain metastases at our institution were retrospectively analyzed. Salvage treatment details were obtained for brain failures. Patients who underwent repeat SRS to the same lesion were excluded. RN was determined based on pathological confirmation or advanced brain imaging consistent with RN in a symptomatic patient. Patients were grouped according to salvage treatment and rates of RN were compared via Fisher's exact tests. Results: Of 284 patients treated with upfront SRS alone, 132 received salvage therapy and 44 received multiple salvage treatments. This included 31 repeat SRS alone, 58 whole brain radiation therapy (WBRT) alone, 28 SRS and WBRT, 7 surgery alone, and 8 surgery with adjuvant radiation. With a median follow-up of 10 months, the rate of RN among all patients was 3.17% (9/284), salvaged patients 4.55% (6/132), and never salvaged patients 1.97% (3/152). Receiving salvage therapy did not significantly increase RN risk (P Z .31). Of the patients requiring salvage treatments, the highest RN rate was among patients that had both salvage SRS and WBRT (delivered as separate salvage therapies) (6/28, 21.42%). RN rate in this group was significantly higher than in those treated with repeat SRS alone (0/31), WBRT alone (0/58), surgery alone (0/7), and surgery with adjuvant radiation (0/8). Comparing salvage WBRT doses <30 Gy versus 30 Gy revealed no effect of dose on RN rate. Additionally, among patients who received multiple SRS treatments, number of treated lesions was not predictive of RN incidence. Conclusion: Our results suggest that initial management approach for recurrent brain metastasis after upfront SRS does not affect the rate of RN. However, the risk of RN significantly increases when patients are treated with both repeat SRS and salvage WBRT. Methods to improve prediction of toxicity and optimize patient selection for salvage treatments are needed.

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“…The diagnosis specific GPA further aids in selecting patients who are ideal candidates for aggressive local therapy. 20 …”

Section: Prognostic Indicesmentioning

confidence: 99%

Stereotactic Radiosurgery to the Resection Cavity for Brain Metastases: Prognostic Factors and Outcomes

Abel¹,

Lederman²,

Ji³

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

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Diagnosis-Specific Prognostic Factors, Indexes, and Treatment Outcomes for Patients With Newly Diagnosed Brain Metastases: A Multi-Institutional Analysis of 4,259 Patients

Cited by 884 publications

References 32 publications

Local treatments for metastases of renal cell carcinoma: a systematic review

Local treatments for metastases of renal cell carcinoma: a systematic review

Management Approach for Recurrent Brain Metastases Following Upfront Radiosurgery May Affect Risk of Subsequent Radiation Necrosis

Stereotactic Radiosurgery to the Resection Cavity for Brain Metastases: Prognostic Factors and Outcomes

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