Survival following whole brain radiation treatment for cerebral metastases: an audit of 474 patients

Broadbent, Andrew; Hruby, George; Tin, Mo Mo; Jackson, Michael; Firth, Ian

doi:10.1016/j.radonc.2004.02.019

Cited by 63 publications

(46 citation statements)

References 26 publications

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“…12,13 These patients may have extended survival, particularly if they have a high performance status or RTOG RPA class I (KPS >70%, no synchronous systemic metastases). 1,9,13,14 Most patients with melanoma brain metastases are not considered surgical candidates. In these patients WBRT (generally 3000 cGy in 10 fractions) has been widely employed to palliate brain metastases, resulting in 3.6 to 4.8-month median survival.…”

Section: Discussionmentioning

confidence: 99%

“…12,13 Extended survival can be achieved in patients with high performance status or Radiation Therapy Oncology Group (RTOG) Recursive Partition Analysis (RPA) Class I (Karnofsky Performance Status [KPS] !70%, primary site controlled, <65 years old, and no evidence of systemic metastases outside the brain). 1,9,13,14 Because multiple, rather than solitary, brain metastases are believed to be more common in melanoma, 2 the majority of patients with melanoma brain metastases are not considered surgical candidates. In unresectable patients, whole brain radiotherapy (WBRT, generally 3000 cGy in 10 fractions) has been widely employed to palliate brain metastases.…”

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confidence: 99%

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Multimodality treatment of melanoma brain metastases incorporating stereotactic radiosurgery (SRS)

Samlowski

Watson

Wang

et al. 2007

Cancer

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BACKGROUND.Brain metastases are a frequent complication in advanced melanoma. A 3.6 to 4.1‐month median survival has been reported after treatment with whole brain radiotherapy. We performed a retrospective analysis of our institutional experience of multimodality treatment utilizing linear accelerator (Linac)‐based stereotactic radiosurgery (SRS).METHODS.Forty‐four melanoma patients with brain metastases underwent 66 SRS treatments for 156 metastatic foci between 1999 and 2004. Patients were treated with initial SRS if ≤5 brain metastases were present. All patients had Karnofsky Performance Status (KPS) ≥70, but 37 patients had active systemic metastases (Recursive Partition Analysis Class 2). Survival was calculated from the time of diagnosis of brain metastases. Minimum follow‐up was 1 year after SRS. The potential role of prognostic factors on survival was evaluated including age, sex, interval from initial diagnosis to brain metastases, surgical resection, addition of whole brain radiotherapy (WBRT), number of initial metastases treated, and number of SRS treatments using Cox univariate analysis.RESULTS.The median survival of melanoma patients with brain metastases was 11.1 months (95% confidence interval [CI]: 8.2–14.9 months) from diagnosis. One‐year and 2‐year survivals were 47.7% and 17.7%, respectively. There was no apparent effect of age or sex. Surgery or multiple stereotactic radiotherapy treatments were associated with prolonged survival. Addition of WBRT to maintain control of brain metastases in a subset of patients did not improve survival.CONCLUSIONS.Our results suggest that aggressive treatment of patients with up to 5 melanoma brain metastases including SRS appears to prolong survival. Subsequent chemotherapy or immunotherapy after SRS may have contributed to the observed outcome. Cancer 2007. © 2007 American Cancer Society.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Multimodality treatment of melanoma brain metastases incorporating stereotactic radiosurgery (SRS)

Samlowski

Watson

Wang

et al. 2007

Cancer

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“…However, only limited prognostic factors for survival have been identified, such as the Radiation Therapy Oncology Group (RTOG) recursive partitioning analysis (RPA) classes (9,10), performance status, presence of extracranial metastases, and aggressive treatment modalities, like surgery or radiosurgery (11,12). Most of the studies, however, have involved heterogeneous patient groups that made the prognostic factors inconsistent.…”

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confidence: 99%

Radiotherapy in Lung Adenocarcinoma with Brain Metastases: Effects of Activating Epidermal Growth Factor Receptor Mutations on Clinical Response

Gow

Chien²,

Chang³

et al. 2008

Clinical Cancer Research

130

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Purpose: Whole-brain radiation therapy (WBRT) has been applied to inoperable brain metastases in lung adenocarcinoma. Recently, an in vitro study showed reduced clonogenic survival of mutant epidermal growth factor receptor (EGFR) lung cancer cell lines in response to ionizing radiation compared with that of the wild type. To elucidate the role of EGFR mutations in radiation treatment, we evaluated the clinical response to WBRT and survival of lung adenocarcinoma patients with brain metastases. Experimental Design: This was a retrospective analysis of 63 patients with brain metastases from lung adenocarcinoma who were treated with WBRT. Demographic data, EGFR mutation status, response to WBRT, and survival data were collected. Clinical response was assessed 1 month after the start of WBRT. Univariate and logistic regression models were used to test potential predictive factors associated with clinical response. Log-rank test and Cox regression were analyzed to identify factors that affected survival. Results: Clinical response to WBRT was observed in 29 patients (46%), with 34 nonresponder patients (54%). Patients with EGFR mutations had higher response rates toWBRTcompared with those with the wild-type (54% versus 24%; P = 0.045). Both the administration of EGFR tyrosine kinase inhibitor (P = 0.034) and EGFR mutation (P = 0.029) were independently associated with response to WBRT. In Cox regression analysis, WBRT responder (P = 0.010) and absence of extracranial metastases (P = 0.002) were associated with better survival. Conclusions: Both the EGFR mutations and the administration of EGFR TKI during WBRT were independent predictors of response to WBRT in brain metastases of lung adenocarcinoma.

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“…The expected short survival of patients treated with WBRT has been an obstacle to consideration of the parotid glands as a risk organ [3]. However, quality-of-life has become one of the most important issues in cancer therapy, and salivary dysfunction can result in severe deterioration of the quality of life.…”

Section: Discussionmentioning

confidence: 99%

Parotid gland as a risk organ in whole brain radiotherapy

Noh

Chun

Nam

et al. 2011

Radiotherapy and Oncology

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Survival following whole brain radiation treatment for cerebral metastases: an audit of 474 patients

Cited by 63 publications

References 26 publications

Multimodality treatment of melanoma brain metastases incorporating stereotactic radiosurgery (SRS)

Multimodality treatment of melanoma brain metastases incorporating stereotactic radiosurgery (SRS)

Radiotherapy in Lung Adenocarcinoma with Brain Metastases: Effects of Activating Epidermal Growth Factor Receptor Mutations on Clinical Response

Parotid gland as a risk organ in whole brain radiotherapy

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