Radiosurgery for non—small cell lung carcinoma metastatic to the brain: long-term outcomes and prognostic factors influencing patient survival time and local tumor control

Sheehan, Jason P.; Sun, Ming-Hsi; Kondziolka, Douglas; Flíckinger, John C.; Lunsford, L. Dade

doi:10.3171/jns.2002.97.6.1276

Cited by 174 publications

(112 citation statements)

References 31 publications

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“…7,8,[10][11][12][13][14] In contrast, >25% of patients with lung cancer develop BM. 15,16 Unfortunately, patients with BM from CRC do not survive as long as patients with BM from other histologies. 6,17,18 This probably is secondary to the burden of systemic disease in patients with metastatic CRC to the brain; concomitant extracerebral metastases have been demonstrated in 77% to 97% of patients.…”

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confidence: 99%

Multidisciplinary management of colorectal brain metastases

Kruser

Chao

Elson

et al. 2008

Cancer

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BACKGROUND.The incidence of brain metastases (BM) from colorectal cancer (CRC) is increasing, and the management of this previously rare complication at a single institution is reported.METHODS.The records of all patients with BM from 1994 to 2005 were reviewed, and 49 patients (33 men, 16 women) with 102 BM from CRC were identified. Associations between patient and tumor characteristics, treatment modality, and survival were assessed.RESULTS.The median age at diagnosis of BM from CRC was 66 years. Forty patients (82%) had other systemic disease. The median survival after a diagnosis of BM from CRC was 5.1 months. Fifteen patients (31%) underwent surgery at some point, 14 patients (29%) underwent stereotactic radiosurgery (SRS), and 42 patients (86%) received whole‐brain radiotherapy during their management. Seven patients (14%) underwent upfront SRS. On multivariate analysis, a longer interval from diagnosis of CRC to diagnosis of BM was associated significantly with shorter survival (p = .01). Sex, Karnofsky performance status, tumor location, recursive partitioning analysis class, and initial treatment modality did not have an impact on survival.CONCLUSIONS.Because BM from CRC are a late‐stage phenomenon, the majority of patients in the current study had other systemic involvement, and survival after CNS involvement was poor. The results indicated that a high prevalence of systemic disease limits the proportion of patients who are strong candidates for upfront SRS, thereby limiting the impact that this modality has on outcomes in this population as a whole. Late development (>1 year after the primary tumor diagnosis) of CNS involvement may predict for poorer survival after therapy for patients with BM from CRC. Cancer 2008. © 2008 American Cancer Society.

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confidence: 99%

Multidisciplinary management of colorectal brain metastases

Kruser

Chao

Elson

et al. 2008

Cancer

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“…Outcomes of brain metastases originating from non-small cell lung carcinoma have been reported by five large studies, including this study [8,10,[27][28]. Three studies reported KPS as a significant prognostic factor on multivariate analysis [8,10], while extracranial control was reported by two studies [10,28], presence of extracranial metastasis was reported by two studies (8,28) and age was reported by two studies (8).…”

Section: Discussionmentioning

confidence: 93%

“…KPS was reported as independent prognostic factor on four studies [8,21,25], extracranial disease control on two studies [6,21], lesion number by one study (current study), age on one study (current study), lesion volume on one study [21], intracranial lesion location by one study [26], and estrogen/progesterone status on one study [21]. Outcomes of brain metastases originating from non-small cell lung carcinoma have been reported by five large studies, including this study [8,10,[27][28]. Three studies reported KPS as a significant prognostic factor on multivariate analysis [8,10], while extracranial control was reported by two studies [10,28], presence of extracranial metastasis was reported by two studies (8,28) and age was reported by two studies (8).…”

Section: Discussionmentioning

confidence: 99%

“…A review of the histology specific literature reveals a wide variation within different histological subtypes, making generalizing any staging criteria difficult [6,8,[10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. To our knowledge, there are five studies (including the current study) reporting outcomes of brain metastasis from breast primaries with a study size of at least 100 patients [6,8,21,25].…”

Section: Discussionmentioning

confidence: 99%

“…Based on these variables, several composite classifications, such as Recursive Partitioning Analysis (RPA) and Graded Prognostic Assessment (GPA), have been proposed to estimate the survival of patients with brain metastases. Though these classifications have been validated by numerous studies [7][8][9][10], the duration of survival and risk factors for mortality vary widely between tumors of different histologies, which is not taken into account by these classifications.…”

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confidence: 99%

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Stereotactic Radiosurgery in Treatment of Cerebral Metastases: Histological Differences in Predictors of Survival

Wolf

Batra²,

Bortoletto³

et al. 2013

Cureus

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Long‐term survivors after gamma knife radiosurgery for brain metastases

Kondziolka

Martin

Flickinger

et al. 2005

Cancer

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116

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BACKGROUND Stereotactic radiosurgery, with or without whole‐brain radiation therapy, has become a valued management choice for patients with brain metastases, although their median survival remains limited. In patients who receive successful extracranial cancer care, patients who have controlled intracranial disease are living longer. The authors evaluated all brain metastasis in patients who lived for ≥ 4 years after radiosurgery to determine clinical and treatment patterns potentially responsible for their outcome. METHODS Six hundred seventy‐seven patients with brain metastases underwent 781 radiosurgery procedures between 1988 and 2000. Data from the entire series were reviewed; and, if patients had ≥ 4 years of survival, then they were evaluated for information on brain and extracranial treatment, symptoms, imaging responses, need for further care, and management morbidity. These long‐term survivors were compared with a cohort who lived for < 3 months after radiosurgery (n = 100 patients). RESULTS Forty‐four patients (6.5%) survived for > 4 years after radiosurgery (mean, 69 mos with 16 patients still alive). The mean age at radiosurgery was 53 years (maximum age, 72 yrs), and the median Karnofsky performance score (KPS) was 90. The lung (n = 15 patients), breast (n = 9 patients), kidney (n = 7 patients), and skin (melanoma; n = 6 patients) were the most frequent primary sites. Two or more organ sites outside the brain were involved in 18 patients (41%), the primary tumor plus lymph nodes were involved in 10 patients (23%), only the primary tumor was involved in 9 patients (20%), and only brain disease was involved in 7 patients (16%), indicating that extended survival was possible even in patients with multiorgan disease. Serial imaging of 133 tumors showed that 99 tumors were smaller (74%), 22 tumors were unchanged (17%), and 12 tumors were larger (9%). Four patients had a permanent neurologic deficit after brain tumor management, and six patients underwent a resection after radiosurgery. Compared with the patients who had limited survival (< 3 mos), long‐term survivors had a higher initial KPS (P = 0.01), fewer brain metastases (P = 0.04), and less extracranial disease (P < 0.00005). CONCLUSIONS Although the expected survival of patients with brain metastases may be limited, selected patients with effective intracranial and extracranial care for malignant disease can have prolonged, good‐quality survival. The extent of extracranial disease at the time of radiosurgery was predictive of outcome, but this does not necessarily mean that patients cannot live for years if treatment is effective. Cancer 2005. © 2005 American Cancer Society.

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Radiosurgery for non—small cell lung carcinoma metastatic to the brain: long-term outcomes and prognostic factors influencing patient survival time and local tumor control

Abstract: Gamma knife surgery for NSCLC metastases affords effective local tumor control in approximately 84% of patients. Early detection of brain metastases, aggressive treatment of systemic disease, and a therapeutic strategy including GKS can afford patients an extended survival time.

Cited by 174 publications

References 31 publications

Multidisciplinary management of colorectal brain metastases

Multidisciplinary management of colorectal brain metastases

Stereotactic Radiosurgery in Treatment of Cerebral Metastases: Histological Differences in Predictors of Survival

Long‐term survivors after gamma knife radiosurgery for brain metastases

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