Long-term survival results after treatment for oligometastatic brain disease

Nieder, Carsten; Hintz, Mandy; Popp, Ilinca; Bilger, Angelika; Grosu, Anca L.

doi:10.1016/j.rpor.2020.03.001

Cited by 15 publications

(17 citation statements)

References 28 publications

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“…Most patients with brain metastases from extracranial primary tumors such as lung or breast cancer receive palliative treatment approaches, because the common pattern of polymetastatic spread may cause compromised performance status (PS) and eventually also limited survival, often in the range of 3–9 months [ 1 ]. Both, longer survival (typically if oligometastases are present [ 2 ]) and shorter survival may be observed, and considerable efforts have been undertaken to predict survival (nomograms, scores, online calculators [ 3 – 5 ]). Given that very short survival often is synonymous to active treatment in the last 30 days of life, oncologists can opt for palliative and supportive care rather than brain-directed therapy [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

30-day mortality in patients treated for brain metastases: extracranial causes dominate

et al. 2022

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Background Established prognostic models, such as the diagnosis-specific graded prognostic assessment, were not designed to specifically address very short survival. Therefore, a brain metastases-specific 30-day mortality model may be relevant. We hypothesized that in-depth evaluation of a carefully defined cohort with short survival, arbitrarily defined as a maximum of 3 months, may provide signals and insights, which facilitate the development of a 30-day mortality model. Methods Retrospective analysis (2011–2021) of patients treated for brain metastases with different approaches. Risk factors for 30-day mortality from radiosurgery or other primary treatment were evaluated. Results The cause of death was unrelated to brain metastases in 61%. Treatment-related death (grade 5 toxicity) did not occur. Completely unexpected death was not observed, e.g. accident, suicide or sudden cardiac death. Logistic regression analysis showed 9 factors associated with 30-day mortality (each assigned 3–6 points) and a point sum was calculated for each patient. The point sum ranged from 0 (no risk factors for death within 30 days present) to 30. The results can be grouped into 3 or 4 risk categories. Eighty-three percent of patients in the highest risk group (> 16 points) died within 30 days, and none survived for more than 2 months. However, many cases of 30-day mortality (more than half) occurred in intermediate risk categories. Conclusion Extracranial tumor progression was the prevailing cause of 30-day mortality and few, if any deaths could be considered relatively unexpected when looking at the complete oncological picture. We were able to develop a multifactorial prediction model. However, the model’s performance was not fully satisfactory and it is not routinely applicable at this point in time, because external validation is needed to confirm our hypothesis-generating findings.

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Section: Introductionmentioning

confidence: 99%

30-day mortality in patients treated for brain metastases: extracranial causes dominate

et al. 2022

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“…The median survival for adenocarcinoma and non-adenocarcinoma is now 15.2 and 9.2 months, respectively [ 5 ]. In patients alive after 2 years of brain metastases diagnosis, the probability of being alive 5 years after treatment is 26% [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Brain metastases from non-small cell lung carcinoma: an overview of classical and novel treatment strategies

Martín

Hernánz

Vallejo

et al. 2022

Rep Pract Oncol Radiother.

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“…Irrespective of these different statistical scenarios, systemic treatment significantly improved survival. At present, many patients receive other types of brain irradiation, such as stereotactic radiosurgery (SRS), which may provide a better therapeutic ratio [16][17][18]. However, sophisticated local treatment is less appealing if followed by best supportive care (BSC) rather than systemic therapy.…”

Section: Introductionmentioning

confidence: 99%

Recursive Partitioning Analysis of Systemic Therapy after Radiotherapy in Patients with Brain Metastases

2021

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Purpose: The purpose of this study was to identify factors associated with the initiation or continuation of systemic treatment after brain irradiation. The outcome of interest was a utilization rate of at least 75%, given that active extracranial disease is common in patients with brain metastases. If left untreated, extracranial disease limits survival, regardless of successful local treatment of the brain metastases. In this context, systemic therapy has been shown to improve survival, e.g., after whole-brain radiotherapy. Patients and Methods: The study included 185 patients with active extracranial disease, 60% of whom received systemic therapy. Results: Survival from the start of brain irradiation was longest in patients who received additional immune checkpoint inhibitors, endocrine treatment, or anti-HER-2 drugs. After uni- and multivariate analyses, Eastern Cooperative Oncology Group performance status (PS) was selected as the first prediction criterion in the recursive partitioning analysis (RPA) decision tree analysis. RPA was successful for patients with PS 0–1, but patients with PS 2 had lower treatment utilization rates (maximum 60–70%, with a disease-dependent impact of age and LabBM score [blood test results]). The highest utilization rates were observed in (1) patients with PS 0 and (2) those with breast cancer, small-cell lung cancer, or lung adenocarcinoma with PS 1. Conclusions: These results inform the multidisciplinary discussion and treatment planning for the common scenario of simultaneous intra- and extracranial metastases.

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Long-term survival results after treatment for oligometastatic brain disease

Cited by 15 publications

References 28 publications

30-day mortality in patients treated for brain metastases: extracranial causes dominate

30-day mortality in patients treated for brain metastases: extracranial causes dominate

Brain metastases from non-small cell lung carcinoma: an overview of classical and novel treatment strategies

Recursive Partitioning Analysis of Systemic Therapy after Radiotherapy in Patients with Brain Metastases

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