Effect of chemotherapy on survival after whole brain radiation therapy for brain metastases: a single-center retrospective analysis

Mayahara, Hiroshi; Sumi, Minako; Ito, Yoshiaki; Sekii, Shuhei; Takahashi, Kana; Inaba, Kouji; Kuroda, Y; Murakami, Naoya; Morota, Madoka; Itami, Jun

doi:10.1007/s00432-012-1198-y

Cited by 6 publications

(4 citation statements)

References 38 publications

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“…This has been seen in previous nonsurgical studies (21, 35, 39). Videtic et al (35) found this survival disparity between men and women who develop NSCLC brain metastases and underwent radiation therapy.…”

Section: Discussionsupporting

confidence: 87%

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Identifying Better Surgical Candidates Among Recursive Partitioning Analysis Class 2 Patients who Underwent Surgery for Intracranial Metastases

et al. 2014

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OBJECTIVE The management of patients with brain metastases is typically dependent on their prognosis. Recursive partitioning analysis (RPA) is the most commonly used method for prognosticating survival, but has limitations for patients in the intermediate class. The aims of this study were to ascertain preoperative risk factors associated with survival, develop a preoperative prognostic grading system, and evaluate the utility of this system in predicting survival for RPA class 2 patients. METHODS Adult patient who underwent intracranial metastatic tumor surgery at an academic tertiary care institution from 1997 to 2011 were retrospectively reviewed. Multivariate proportional hazards regression analysis was used to identify preoperative factors associated with survival. The identified associations were then used to develop a grading system. Survival as a function of time was plotted using the Kaplan-Meier method, and survival rates were compared using log-rank analyses. RESULTS A total of 421 (59%) of 708 patients were RPA class 2. The preoperative factors found to be associated with poorer survival were: male gender (P < 0.0001), motor deficit (P = 0.0007), cognitive deficit (P = 0.0004), nonsolitary metastases (P = 0.002), and tumor size >2 cm (P = 0.003). Patients having 0–1, 2, and 3–5 of these variables were assigned a preoperative grade of A, B, and C, respectively. Patients with a preoperative grade of A, B, and C had a median survival of 17.0, 10.3, and 7.3 months, respectively. These grades had distinct survival times (P < 0.05). CONCLUSIONS The present study devised a preoperative grading system that may provide prognostic information for RPA class 2 patients, which may also guide medical and surgical therapies before any intervention is pursued.

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Section: Discussionsupporting

confidence: 87%

“…The median survival for male patients was 5.5 months compared with 6.3 months for female patients. This improved survival for female patients has been attributed to gender differences in baseline health statuses, hormonal levels, and propensity for different tumor types (21, 35, 39). …”

Section: Discussionmentioning

confidence: 99%

Identifying Better Surgical Candidates Among Recursive Partitioning Analysis Class 2 Patients who Underwent Surgery for Intracranial Metastases

et al. 2014

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“…WBRT has been widely used for the management of brain metastases, particularly multiple brain metastases, for decades, as it results in the rapid improvement of neurological symptoms and prolongs survival (12). However, radiation- induced dementia is a well-known side effect, although it does increase the median survival time to 4–6 months (2).…”

Section: Discussionmentioning

confidence: 99%

CyberKnife therapy of 24 multiple brain metastases from lung cancer: A case report

Yang

Wang

et al. 2013

Oncology Letters

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Brain metastasis is a significant cause of morbidity and mortality and a critical complication of non-central nervous system primary carcinoma. The present study describes the clinical case of a 46-year-old male with lung cancer and life-threatening brain metastases. The patient was diagnosed with lung cancer with a clinical stage of T2N0M1 (stage IV). Six months after the initial diagnosis and administration of conformal radiotherapy combined with three cycles of chemotherapy, an enhanced computed tomography (CT) scan of the brain revealed abnormalities with double-dosing of intravenous contrast. The CT scan identified >24 lesions scattered in the whole brain. The patient was treated with three-fraction Cyberknife radiotherapy at 22 Gy, delivered to the brain metastases at the Center for Tumor Treatment of People’s Liberation Army 107th Hospital. Following CyberKnife therapy, a CT scan of the brain revealed that most of the tumors had disappeared with almost no residual traces. The stereotactic radiosurgery (SRS) conducted using CyberKnife, an image-guided frameless robotic technology for whole-body radiosurgery, had produced a marked response. The present case report demonstrates that CyberKnife therapy plays a significant role in the management of multiple meta-static brain tumors.

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“…The following parameters have been demonstrated to be prognostic factors: Karinofsky performance status (KPS); age; treatment history; extracranial metastases; systemic tumor activity; lactic dehydrogenase (LDH) level (20)(21)(22)(23)(24)(25)(26)(27).…”

Section: Introductionmentioning

confidence: 99%

Examination of the predictive factors of the response to whole brain radiotherapy for brain metastases from lung cancer using MRI

et al. 2017

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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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Effect of chemotherapy on survival after whole brain radiation therapy for brain metastases: a single-center retrospective analysis

Cited by 6 publications

References 38 publications

Identifying Better Surgical Candidates Among Recursive Partitioning Analysis Class 2 Patients who Underwent Surgery for Intracranial Metastases

Identifying Better Surgical Candidates Among Recursive Partitioning Analysis Class 2 Patients who Underwent Surgery for Intracranial Metastases

CyberKnife therapy of 24 multiple brain metastases from lung cancer: A case report

Examination of the predictive factors of the response to whole brain radiotherapy for brain metastases from lung cancer using MRI

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