Survival and quality of life after whole brain radiotherapy with 3D conformal boost in the treatment of brain metastases

Şuteu, Patricia; Fekete, Zsolt; Todor, N.; Nagy, Viorica

doi:10.15386/cjmed-1040

Cited by 12 publications

(10 citation statements)

References 50 publications

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“…TNBC with symptomatic brain metastasis is preferentially treated with radiation therapy rather than systemic therapy. Patients with brain metastases manifest various symptoms including headache (61.9%), nausea and vomiting (45.7%), visual disorders (26.3%), seizures (30.4%), and motor dysfunction (46.6%) [ 76 ]. Corticosteroids are usually administered to reduce these neurological symptoms during radiation therapy as well as after treatment.…”

Section: Future Prospectsmentioning

confidence: 99%

Molecular and cellular mechanisms underlying brain metastasis of breast cancer

Hosonaga

Saya

Arima

2020

Cancer Metastasis Rev

109

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Metastasis of cancer cells to the brain occurs frequently in patients with certain subtypes of breast cancer. In particular, patients with HER2-positive or triple-negative breast cancer are at high risk for the development of brain metastases. Despite recent advances in the treatment of primary breast tumors, the prognosis of breast cancer patients with brain metastases remains poor. A better understanding of the molecular and cellular mechanisms underlying brain metastasis might be expected to lead to improvements in the overall survival rate for these patients. Recent studies have revealed complex interactions between metastatic cancer cells and their microenvironment in the brain. Such interactions result in the activation of various signaling pathways related to metastasis in both cancer cells and cells of the microenvironment including astrocytes and microglia. In this review, we focus on such interactions and on their role both in the metastatic process and as potential targets for therapeutic intervention.

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Section: Future Prospectsmentioning

confidence: 99%

Molecular and cellular mechanisms underlying brain metastasis of breast cancer

Hosonaga

Saya

Arima

2020

Cancer Metastasis Rev

109

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“…Overall survival after BM diagnosis (mOS) was the time from the diagnosis of BM to death or last follow-up. We defined intracranial progression-free survival (iPFS) as the interval between the diagnosis of BM and intracranial progression or mortality from any cause [8,9]. The therapeutic effects were evaluated at 3 months using the RECIST criteria [10].…”

Section: Evaluation Criteriamentioning

confidence: 99%

Prognostic analysis of patients with non-small cell lung cancer harboring exon 19 or 21 mutation in the epidermal growth factor gene and brain metastases

et al. 2020

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Background: In 1997, the Radiation Therapy Oncology Group (RTOG) put forward the recursive partitioning analysis classification for the prognosis of brain metastases (BMs), but this system does not take into account the epidermal growth factor receptor (EGFR) mutations. The aim of the study is to assess the prognosis of patients with EGFRmutated non-small cell lung cancer (NSCLC) and BMs in the era of tyrosine kinase inhibitor (TKI) availability. Methods: This was a retrospective study of consecutive patients with EGFR-mutated (exon 19 or 21) NSCLC diagnosed between 01/2011 and 12/2014 at the Tianjin Medical University Cancer Institute & Hospital and who were ultimately diagnosed with BMs. The patients were stage I-III at initial presentation and developed BMs as the first progression. Overall survival (OS), OS after BM diagnosis (mOS), intracranial progression-free survival (iPFS), response to treatment, and adverse reactions were analyzed. Results: Median survival was 35 months, and the 1-and 2-year survival rates were 95.6% (108/113) and 74.3% (84/ 113). The 3-month CR + PR rates of radiotherapy(R), chemotherapy(C), targeted treatment(T), and targeted treatment + radiotherapy(T+R) after BMs were 63.0% (17/27), 26.7% (4/15), 50.0% (7/14), and 89.7% (35/39), respectively. The median survival of the four treatments was 20, 9, 12, and 25 months after BMs, respectively (P = 0.001). Multivariable analysis showed that < 3 BMs (odds ratio (OR) = 3.34, 95% confidence interval (CI): 1.89-5.91, P < 0.001) and treatment after BMs (OR = 0.68, 95%CI: 0.54-0.85, P = 0.001) were independently associated with better prognosis. Conclusions: The prognosis of patients with NSCLC and EGFR mutation in exon 19 or 21 after BM is associated with the number of brain metastasis and the treatment method. Targeted treatment combined with radiotherapy may have some advantages over other treatments, but further study is warranted to validate the results.

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“…In the past, WBRT has been the standard for salvage brain treatment with conflicting results [ 113 ]. Specific data on local and distant control rates after salvage WBRT are scarce, which can be possibly explained by the short survival of these patients [ 114 ]. More recently, a small number of trials were published, reporting on the use of SRS for re-irradiation of BMs after previous WBRT [ 115 , 116 , 117 ].…”

Section: The Challenge Of Recurrence Radioresistance and Radionecrosismentioning

confidence: 99%

Challenges and Novel Opportunities of Radiation Therapy for Brain Metastases in Non-Small Cell Lung Cancer

Jablonska

Bosch-Barrera

Serrano

et al. 2021

Cancers

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Approximately 20% patients with non-small cell lung cancer (NSCLC) present with CNS spread at the time of diagnosis and 25–50% are found to have brain metastases (BMs) during the course of the disease. The improvement in the diagnostic tools and screening, as well as the use of new systemic therapies have contributed to a more precise diagnosis and prolonged survival of lung cancer patients with more time for BMs development. In the past, most of the systemic therapies failed intracranially because of the inability to effectively cross the blood brain barrier. Some of the new targeted therapies, especially the group of tyrosine kinase inhibitors (TKIs) have shown durable CNS response. However, the use of ionizing radiation remains vital in the management of metastatic brain disease. Although a decrease in CNS-related deaths has been achieved over the past decade, many challenges arise from the need of multiple and repeated brain radiation treatments, which carry along not insignificant risks and toxicity. The combination of stereotactic radiotherapy and systemic treatments in terms of effectiveness and adverse effects, such as radionecrosis, remains a subject of ongoing investigation. This review discusses the challenges of the use of radiation therapy in NSCLC BMs in view of different systemic treatments such as chemotherapy, TKIs and immunotherapy. It also outlines the future perspectives and strategies for personalized BMs management.

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Survival and quality of life after whole brain radiotherapy with 3D conformal boost in the treatment of brain metastases

Cited by 12 publications

References 50 publications

Molecular and cellular mechanisms underlying brain metastasis of breast cancer

Molecular and cellular mechanisms underlying brain metastasis of breast cancer

Prognostic analysis of patients with non-small cell lung cancer harboring exon 19 or 21 mutation in the epidermal growth factor gene and brain metastases

Challenges and Novel Opportunities of Radiation Therapy for Brain Metastases in Non-Small Cell Lung Cancer

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