Linac Radiosurgery Versus Whole Brain Radiotherapy for Brain Metastases

BACKGROUND AND PURPOSE: For patients with inoperable brain metastases, whole brain radiotherapy (WBRT) has been the standard treatment for decades. Radiosurgery is an effective alternative strategy, but has failed to show a substantial survival benefit so far. The prognostic factors derived from the RTOG recursive partitioning analysis (RPA) provide a framework that allows a nonrandomized comparison of the two modalities. PATIENTS AND METHODS: From 1991 to 1998, 117 patients with one to three previously untreated cerebral metastases underwent single-dose linac radiosurgery (median dose 20 Gy) without adjuvant WBRT. After radiosurgery, 26/117 patients (22%) had salvage WBRT, radiosurgery or neurosurgical resection of recurrent (4/117) and/or new (24/117) metastases. Survival of these patients was compared to a historical group of 138 patients with one to three lesions treated by WBRT (30-36 Gy/3-Gy fractions) from 1978 to 1991; only nine of these patients (7%) had salvage WBRT. All patients were classified into the three RPA prognostic classes based on age, performance score, and presence of extracranial tumor manifestations. RESULTS: In RPA class I (Karnofsky performance score > or = 70, primary tumor controlled, no other metastases, age < 65 years), radiosurgery resulted in a median survival of 25.4 months (n = 23, confidence interval [CI] 5.8-45.0) which was significantly longer than for WBRT (n = 9, 4.7 months, CI 3.8-5.5; p < 0.0001). In RPA class III (Karnofsky performance score < 70), no significant difference in survival between radiosurgery (n = 20, 4.2 months, CI 3.2-5.3) and WBRT (n = 68, 2.5 months, CI 2.2-2.8) was found. In RPA class II (all other patients), radiosurgery produced a small, but significant survival advantage (radiosurgery: n = 74, 5.9 months, CI 3.2-8.5, WBRT: n = 61, 4.1 months, CI 3.4-4.9; p < 0.04). CONCLUSION: Radiosurgery in patients with one to three cerebral metastases results in a substantial survival benefit only in younger patients with a low systemic tumor burden when compared to WBRT alone. It cannot be excluded that this effect is partially caused by the available salvage options after radiosurgery.     

Comparison of stereotactic radiosurgery (SRS) alone and whole brain radiotherapy (WBRT) plus a stereotactic boost (WBRT + SRS) for one to three brain metastases

Background

The best available treatment of patients with one to three brain metastases is still unclear. This study compared the results of stereotactic radiosurgery (SRS) alone and whole brain radiotherapy (WBRT) plus SRS (WBRT + SRS).

Patients and Methods

Survival (OS), intracerebral control (IC), and local control of treated metastases (LC) were retrospectively analyzed in 144 patients receiving SRS alone (n = 93) or WBRT + SRS (n = 51). Eight additional potential prognostic factors were evaluated: age, gender, Eastern Cooperative Oncology Group performance score (ECOG-PS), tumor type, number of brain metastases, extracerebral metastases, recursive partitioning analysis (RPA) class, and interval from tumor diagnosis to irradiation. Subgroup analyses were performed for RPA class I and II patients.

Results

1-year-OS was 53% after SRS and 56% after WBRT + SRS (p = 0.24). 1-year-IC rates were 51% and 66% (p = 0.015), respectively. 1-year-LC rates were 66% and 87% (p = 0.003), respectively. On multivariate analyses, OS was associated with age (p = 0.004), ECOG-PS (p = 0.005), extracerebral metastases (p < 0.001), RPA class (p < 0.001), and interval from tumor diagnosis to irradiation (p < 0.001). IC was associated with interval from tumor diagnosis to irradiation (p = 0.004) and almost with treatment (p = 0.09), and LC with treatment (p = 0.026) and almost with interval (p = 0.08). The results of the subgroup analyses were similar to those of the entire cohort. The increase in IC was stronger in RPA class I patients.

Conclusion

WBRT + SRS resulted in better IC and LC but not better OS than SRS alone. Because also IC and LC are important end-points, additional WBRT appears justified in patients with one to three brain metastases, in particular in RPA class I patients.     

Treatment of Solitary Brain Metastasis

BACKGROUND: Whole brain radiation therapy (WBRT) is reported to improve local control after resection of brain metastases. Improvement of survival was only observed in patients with controlled extracranial disease. The optimum radiation schedule has yet to be defined. The authors' experience with a postoperative approach including WBRT and a radiation boost to the metastatic site is presented. PATIENTS AND METHODS: Criteria for inclusion into this retrospective analysis were solitary brain metastasis, Karnofsky performance status > or = 70%, and controlled extracranial disease. Two therapies were compared for local control and survival: surgery followed by 40 Gy WBRT (group A) versus surgery followed by 40 Gy WBRT and a 10 Gy boost (group B). Statistical analysis was performed using the Kaplan-Meier method and log-rank test. RESULTS: 33 patients were included (17 group A, 16 group B). The results suggested better local control (p = 0.0087) and survival (p = 0.0023) for group B. 17/17 patients (100%) of group A and 13/16 patients (81%) of group B showed progression of brain metastasis, 8/17 and 3/16 patients in the area of metastatic surgery. Median time to progression was 7 (1-22) months in group A and 12 (3-42) months in group B. The number of cancer-related deaths amounted to 17/17 (100%) in group A after a median interval of 9 (3-26) months, and to 9/16 (56%) in group B after 14 (4-46) months. CONCLUSION: After resection of solitary brain metastasis, a radiation boost in addition to WBRT seems to improve local control and survival when compared to postoperative WBRT alone. The results should be confirmed in a larger prospective trial.     

Efficacy of whole brain radiotherapy combined with fractionated stereotactic radiotherapy in metastatic brain tumors, and prognostic factors

PURPOSE: We attempted to analyze the effectiveness of whole brain radiotherapy (WBRT) combined with fractionated stereotactic radiotherapy (FSRT) in brain metastases. METHODS: Thirty-seven metastatic brain tumors in 29 patients without previous treatment were treated with WBRT plus FSRT, from October 1996 to February 2002. Four of the patients received stereotactic radiosurgery (SRS) prior to WBRT. Non-small cell lung cancer was the most common type of primary tumor (20/29). The total dose to the whole brain ranged from 30 Gy to 40 Gy, and the boost dose from FSRT ranged from 12 Gy to 40 Gy. End points were survival rate and local control rates. Factors influencing survival were evaluated. RESULTS: Median survival was 13 months, and actuarial survival rates at one and two years were 81% and 39%, respectively. Actuarial one and two year local control rates for all lesions were 78% and 71%, respectively. Survival was significantly associated with age, tumor size, presence of active extracranial tumors, and performance status. No acute or delayed complications were observed. CONCLUSIONS: We believe that WBRT plus FSRT should be included in the treatment options for metastatic brain tumors, and we consider the effect of this non-invasive method to be quite good in patients with good prognostic factors, although other invasive modalities could also be effective in them.     

全脑放疗联合与不联合立体定向放疗治疗脑转移瘤疗效对比的Meta分析

目的 评价脑转移瘤全脑放射治疗(WBRT)联合与不联合立体定向放疗(SRT)的疗效对比.方法 采用Meta分析方法收集脑转移瘤WBRT联合与不联合SRT效果比较的相关文献进行综合评价,数据分析采用RevMan 4.2软件.结果 最终纳入5篇文献(4篇随机对照试验,1篇队列研究),共包括559例患者.Meta分析结果显示:在提高脑转移瘤患者肿瘤1年局控率方面,WBRT联合SRT明显优于单纯WBRT治疗(OR=6.35,95％CI 1.92～ 20.97);在改善患者1年总体生存率方面,WBRT联合SRT与单纯WBRT治疗并无统计学差异(OR=1.46,95％CI 0.96～2.22);将患者细分为单发脑转移瘤和多发脑转移瘤后进行分析显示,与单纯WBRT治疗比较,WBRT联合SRT在提高单发脑转移瘤患者1年生存率方面存在优势(OR=2.23,95％CI 1.05～4.75),对于多发脑转移瘤患者则无明显优势(OR=1.09,95％CI 0.53～2.25).结论 WB RT联合SRT是一种较为合理的脑转移瘤综合治疗方式,尤其对于单发脑转移瘤患者,除改善肿瘤局控率外,还可提高患者1年生存率.     

Radiosurgery for brain metastases at the Royal Adelaide Hospital: are we treating the right patients?

Although non-randomized data strongly suggest improved outcome from radiosurgery (RS) for brain metastases relative to whole brain radiotherapy (WBRT) alone, selection factors account for much of the observed differences. This retrospective review of the 16 brain metastases patients treated so far with RS at the Royal Adelaide Hospital confirms a median survival of 10.1 months, consistent with recent multi-institutional pooled results and significantly longer than the median survival of 3-6 months typically reported for WBRT alone. The emerging randomized trials comparing surgery, RS and WBRT for brain metastases are reviewed in the context of the Radiation Therapy Oncology Group Recursive Partitioning Analysis prognostic Class concept in order to assess whether we are using this resource intensive technique to treat the 'right' patients. We conclude that it is reasonable to continue our current policy of considering RS primarily for patients of good performance status with solitary brain metastases. We have a flexible approach to adjuvant WBRT which appears to decrease brain relapse, but not improve survival.     

立体定向分次放疗联合全脑放射治疗脑转移瘤疗效分析

目的 分析X刀分次立体定向放疗(FSRT)联合全脑照射(WBRT)治疗脑转移瘤疗效。方法 回顾性分析51例脑转移瘤FSRT+WBRT和35例脑转移瘤单纯WBRT的结果,比较分析两者有效率、生存率的差异。结果 FSRT+WBRT、WBRT组完全缓解率分别为49%、26%(P<0.05),中位生存期分别为(11.0±1.5)、(6.5±0.5)个月(P<0.05),18个月生存率分别为24%、9%(P<0.05)。两组有效率(8%、71%,P>0.05)和6、12个月生存率(63%、41%,51%、23%,P>0.05)相似。 结论 X刀FSRT联合WBRT治疗脑转移瘤损伤小、安全、延长生存期,疗效优于单纯全颅放疗。     

Comparison of Short-Course versus Long-Course Whole-Brain Radiotherapy in the Treatment of Brain Metastases

BACKGROUND AND PURPOSE: Whole-brain radiotherapy (WBRT) is the most common treatment for brain metastases. Most of these patients have a poor survival prognosis. Therefore, a short radiation program is preferred, if it provides a similar outcome as longer programs. This study compares 20 Gy in five fractions (treatment time: 1 week) to longer programs, with higher doses including 30 Gy in ten fractions (2 weeks) and 40 Gy in 20 fractions (4 weeks). PATIENTS AND METHODS: Data regarding 1,085 patients treated with WBRT for brain metastases were retrospectively analyzed. 387 patients received 20 Gy in five fractions, and 698 patients received higher doses (30 Gy in ten fractions, n = 527, or 40 Gy in 20 fractions, n = 171). In addition, eight potential prognostic factors were investigated including age, sex, Karnofsky Performance Score (KPS), tumor type, interval from tumor diagnosis to WBRT, number of brain metastases, extracranial metastases, and recursive partitioning analysis (RPA) class. Subgroup analyses were performed for each RPA class individually. RESULTS: The WBRT schedule had no significant impact on survival (p = 0.415). On multivariate analysis, improved survival was significantly associated with age < or = 60 years (risk ratio [RR]: 1.28; p < 0.001), KPS > or = 70 (RR: 1.73; p = 0.002), lack of extracranial metastases (RR: 1.27; p = 0.007), interval from tumor diagnosis to WBRT > 8 months (RR: 1.19; p = 0.011), and lower RPA class (RR: 1.56; p < 0.001). The subgroup analyses for each RPA class did not reveal a significant association between WBRT schedule and survival. CONCLUSION: Short-course WBRT with 20 Gy in five fractions is preferable for most patients, because it is associated with similar survival as longer programs and is less time-consuming.     

Prognostic Factors for Brain Metastases after Whole Brain Radiotherapy

PURPOSE: Prognostic factors for overall survival of patients treated for brain metastases with whole brain radiotherapy (WBRT) at a single institution were retrospectively evaluated, and the validity of the RTOG recursive partitioning analysis (RPA) for prognostic classes was assessed. PATIENTS AND METHODS: The data of all patients (n = 268) with brain metastases from solid tumors homogeneously treated between 01/1997 and 09/1999 at the University of Heidelberg, Germany, with WBRT without surgery or radiosurgery were reviewed. 13 different patient- and therapy-related variables were evaluated for prognosis. Second, a grouping of the study cohort was performed according to the RTOG RPA prognostic classes. RESULTS: Median survival of the whole population after the start of WBRT was 3.8 months. The 1-year survival rate was 19%. Multivariate analysis revealed that only the Karnofsky performance status, control of the primary and no extracranial disease were independent prognostic factors for overall survival. These are also the main determinants of the RTOG RPA classes. Applying the RTOG RPA classes to the authors' data set revealed three subgroups with significantly different prognosis. CONCLUSION: Based on this analysis, prognostic factors for survival after WBRT in patients with brain metastases could be identified. A total of 19% (n = 44/232) survived > or = 1 year, whereas overall survival was poor. The potential value of the RPA classes in estimating the patient's prognosis could be confirmed.     

A New Scoring System to Predicting the Survival of Patients Treated with Whole-Brain Radiotherapy for Brain Metastases

PURPOSE: To create a scoring system to estimate survival of patients who received whole-brain radiotherapy (WBRT) for brain metastases. MATERIAL AND METHODS: Based on a multivariate analysis of 1,085 retrospectively analyzed patients, a scoring system was developed. This score was based on the four significant prognostic factors found in the multivariate analysis including: age, performance status, extracranial metastases at the time of WBRT, and interval between tumor diagnosis and WBRT. The score for each prognostic factor was determined by dividing the 6-month survival rate (in %) by 10. The total score represented the sum of the partial scores for each prognostic factor. Total scores ranged from 9 to 18 points, and patients were divided into four groups. For each group, survival was compared for short-course (5 x 4 Gy) versus longer-course WBRT (10 x 3 Gy/20 x 2 Gy). RESULTS: Actuarial 6-month survival rates were 6% for patients with scores of 9-10 points, 15% for those with scores of 11-13 points, 43% for those with scores of 14-16 points, and 76% for those with scores of 17-18 points (p < 0.001). Longer-course WBRT was not associated with better survival than short-course WBRT in any of the four groups. CONCLUSION: Patients with brain metastases receiving WBRT can be grouped with this score to estimate survival. Short-course and longer-course WBRT resulted in similar survival in all groups studied. However, in the more favorable patients with scores of 17-18, longer-course WBRT with lower doses per fraction should be considered, as these schedules have been associated with less neurocognitive toxicity.     

伽玛刀立体定向放疗结合全脑照射治疗脑转移瘤临床效果分析

目的 分析立体定向放疗结合全脑照射治疗脑转移瘤的疗效和预后,同时观察服用替莫唑胺(TMZ)与放疗结合对患者生存率的影响。方法 脑转移瘤患者52例,按照治疗方法不同分为2组,一组为全脑照射(WBRT)+立体定向放疗(SRT,伽玛刀),共35例,一组为单纯SRT,共17例。全脑放疗分次剂量为1.8~3.0 Gy/次,1 次/d,5 次/周,总剂量D_T30~40 Gy,WBRT+SRT组全脑后伽玛刀补量采用45%~75%等剂量曲线包绕PTV,边缘剂量12~15 Gy,中心剂量20~30 Gy。单纯SRT组分次立体定向放疗采用45%~75%等剂量曲线包绕PTV,边缘剂量36~40 Gy,中心剂量70~80 Gy。随访1~2年。所选52例患者中有20例患者放疗期间及放疗后服用替莫唑胺胶囊,同步化疗组化疗方案为:口服替莫唑胺75 mg/m²,1次/d,直至放疗结束,放疗结束后再服用3~6个月,剂量改为150 mg/m²。结果 放射治疗后1~3个月,复查CT/MRI显示总有效率(CR+PR)为84.62%,WBRT+SRT组有效率为88.57%,SRT组有效率为76.47%;肿瘤的6个月及1年的局部控制率分别为92.10%和85.20%。WBRT+SRT组的平均生存期13.2个月,中位生存期11个月;6个月生存率为71.40%,12个月生存率为54.30%,18个月生存率为14.30%。SRT组的平均生存期10.2个月,中位生存期9个月;6个月生存率为41.20%,12个月生存率为23.50%,18个月生存率为5.88%。替莫唑胺+放疗与单纯放疗的6个月、12个月及18个月生存率分别为80.00%和56.30%、60.00%和37.50%、10.00%和12.50%。结论 WBRT+SRT治疗脑转移瘤总体上优于单纯SRT治疗。放疗+TMZ联合治疗与单纯放疗相比,替莫唑胺在放疗过程中服用可提高患者生存率,不良反应无显著增加。     

脑部放疗的选择对驱动基因阳性非小细胞肺癌脑转移患者生存的影响

目的 探讨在既往未使用过酪氨酸激酶抑制剂（TKI）的表皮生长因子受体（EGFR）突变的非小细胞肺癌脑转移患者中,脑放疗介入的时间及脑放疗方式的选择。方法 回顾性分析武汉大学中南医院放化疗科2014年1月至2018年9月收治的69例合并脑转移的EGFR突变的非小细胞肺癌（NSCLC）患者,根据脑部放疗介入时间将患者分为两组：早放疗组（45例）即确诊脑转移后先行脑部放疗并接受TKI药物治疗,晚放疗组（24例）即先使用TKI药物至出现脑转移病灶进展后行脑放疗,早放疗组根据脑放疗方式可分为早全脑放射治疗（WBRT）组（20例）,早立体定向放射外科（SRS）组（25例）,比较患者的总生存（OS）、颅内无进展生存（iPFS）及无进展生存（PFS）。结果 入组69例患者的中位OS为31.2个月,早放疗组与晚放疗组1年和2年OS分别为95%、64%和80%、35%,两组差异有统计学意义（χ²=8.87,P<0.05）。进一步分析显示,早WBRT组、早SRS组及晚放疗组1年和2年OS分别为95%、96%、80%和 42%、88%、35%（χ²=12.01,P<0.05）。早SRS组较晚放疗组有OS获益（HR：0.10,95%CI：0.23~0.46,P=0.003）,而早WBRT组较晚放疗组OS未见显著获益（HR：0.54,95%CI：0.21~1.32,P=0.180）。早放疗组与晚放疗组iPFS及PFS比较差异均无统计学意义（P>0.05）。结论 对于既往未接受TKI药物治疗的EGFR突变的NSCLC脑转移患者,尽早脑部放疗介入有助于延长患者生存期,其中使用SRS较使用WBRT获益明显。     

非小细胞肺癌脑转移不同治疗方法的疗效分析

目的 回顾性分析非小细胞肺癌脑转移预后因素,探讨以全脑放疗为主的不同方案多学科综合治疗的疗效。方法 4年中共收治非小细胞肺癌脑转移患者 251例,其中行全脑放疗联合其他多学科治疗患者183例。分析这183例患者临床特点,结合随访资料进行预后因素分析,用Kaplan-Meier 法和Logrank 法分析比较生存率, 用Cox 模型进行多因素回归分析。结果 全组中位生存时间10.0个月。1、2、3年生存率分别为40.6%、16.6%、11.3%。Cox 模型多因素分析显示RPA分级、体重下降与否、血清LDH是否升高和不同的多学科治疗方案为独立预后因素。多因素和单因素生存分析均提示治疗方案明显影响预后。对单个颅内转移灶患者开颅手术+术后放化疗预后好,中位生存期达22个月;全脑放疗联合分子靶向治疗中位生存期达13个月;全脑放疗联合化疗与单纯全脑放疗中位生存期相似均为9个月;对97例全脑放疗联合化疗患者分层分析提示同期放化疗疗效优于序贯放化疗,中位生存期分别为13个月和9个月(χ²=3.89,P=0.049)。结论 RPA分级、体重下降与否、血清LDH水平是影响非小细胞肺癌脑转移患者预后的重要因素。治疗方案影响预后,积极的多学科综合治疗疗效优于单纯全脑放疗。对于一般情况较好能耐受手术的单发脑转移患者,开颅手术+术后放化疗是一种较好的治疗手段。     

The Role of Postoperative Radiotherapy after Resection of a Single Brain Metastasis

BACKGROUND AND PURPOSE: The extent of treatment in patients with single brain metastasis is a controversial topic. Especially the issue of whole-brain radiotherapy (WBRT) after local treatment of the lesion is largely unresolved. Therefore, the authors performed a pooled analysis of all available clinical data, based on a comprehensive literature search and on prospectively defined inclusion criteria and endpoints (in particular local brain control at the original site and development of new brain metastases). MATERIAL AND METHODS: Overall, 643 patients from ten publications met the inclusion criteria. 106 patients were treated with surgery alone, 66 with surgery plus local radiotherapy, and the others with surgery plus WBRT (Table 1). RESULTS: Both types of additional radiotherapy significantly improved local control at the original site (relative risk of local failure <0.5). WBRT also reduced new lesions significantly (relative risk 0.6). Within the available range of doses, no significant dose-response relationship was observed (Figure 1). Even after WBRT, new lesions remained the predominant type of brain failure. One of the underlying causes might be continuous reseeding of cells from active extracranial sites. Toxicity and quality of life were not well described in the publications. CONCLUSION: The present data favor moderate-dose WBRT, but the pros and cons of each option should be discussed with each patient. Higher radiation doses or local boost treatment are not supported by these data, but might be considered under certain circumstances, e.g., after incomplete resection.     

Whole-Brain Radiotherapy with 20 Gy in 5 Fractions for Brain Metastases in Patients with Cancer of Unknown Primary (CUP)

BACKGROUND: Whole brain radiotherapy (WBRT) is the most common treatment for brain metastases. Survival of patients with cancer of unknown primary (CUP) presenting with brain metastases is extremely poor. A radiation program with a short overall treatment time (short-course RT) would be preferable to longer programs if it provides similar outcomes. This study compares short-course RT with 20 Gy in 5 fractions (5 x 4 Gy) given over 5 days to longer programs in CUP patients. PATIENTS AND METHODS: Data regarding 101 CUP patients who received either short course WBRT (n=34) with 5 x 4 Gy or long-course WBRT (n=67) with 10 x 3 Gy given over 2 weeks or 20 x 2 Gy given over 4 weeks for brain metastases were analyzed retrospectively. Six additional potential prognostic factors were investigated: age, gender, Karnofsky performance score (KPS), number of brain metastases, extracranial metastases, RPA-(Recursive Partitioning Analysis-)class. RESULTS: On univariate analysis, the radiation program was not associated with survival (p=0.88) nor intracerebral control (p=0.36). Improved survival was associated with KPS >or= 70 (p<0.001), absence of extracranial metastases (p<0.001), and RPA-class 1 (p<0.001). On multivariate analyses, KPS (risk ratio [RR]: 4.55; p<0.001), extracranial metastases (RR: 1.70; p=0.018), and RPA-class (RR: 2.86; p<0.001) maintained significance. On univariate analysis, KPS (p<0.001) and RPA-class (p<0.001) were significantly associated with intracerebral control. On multivariate analyses, KPS (RR: 2.72; p<0.001) and RPA-class (RR: 2.09; p<0.001) remained significant. CONCLUSION: Short-course WBRT with 5 x 4 Gy provided similar intracerebral control and survival as longer programs for the treatment of brain metastases in CUP patients. 5 x 4 Gy appears preferable because it is more convenient for patients.     

Could helical tomotherapy do whole brain radiotherapy and radiosurgery?

Whole brain radiotherapy (WBRT) remains the standard management of breast cancer patients with brain metastases, allowing for symptomatic improvement and good local control in most patients. However, its results remain suboptimal in terms of both efficacy and toxicity. In highly selected breast cancer patients, stereotaxic radiotherapy demonstrates a very good local control with a low toxicity. With the purpose of improving the efficacy/toxicity ratio, we report the association of integrated boost with WBRT in a breast cancer patient with brain metastases. Two and a half years after completion of helical tomotherapy (HT), the patient experienced clinical and radiological complete remission of her brain disease. No delayed toxicity occurred and the patient kept her hair without need of radiosurgical procedure. The HT provided a high dosimetric homogeneity, delivering integrated radiation boosts, and avoiding critical structures involved in long-term neurological toxicity. Further assessment is required and recruitment of breast cancer patients into clinical trials is encouraged.     

肺癌脑转移44例治疗分析

目的比较不同治疗方法对肺癌脑转移的疗效。方法对44例肺癌脑转移患者资料进行回顾性分析。根据治疗方法的不同分为单纯放疗组23例(全脑放疗10例,立体定向放疗13例),全脑放疗或立体定向放疗联合全身化疗(放疗+化疗)组17例,对症治疗组4例,比较其生存期和生存率。结果 单纯放疗组的中位生存期为8.3个月,1年生存率为17.4%;放疗+化疗组中位生存期为13.2个月,1年生存率为52.9%;对症治疗组的中位生存期为1.7个月,1年生存率为0%。放疗+化疗组比单纯放疗及对症治疗组具有更好的疗效(P<0.05)。结论放疗联合化疗是肺癌脑转移患者比较有效的治疗方法,可延长生存期。     

Recursive Partitioning Analysis (RPA) Class Does Not Predict Survival in Patients with Four or More Brain Metastases

BACKGROUND: We evaluated prognostic factors for survival in patients with four or more brain metastases in order to determine whether intense local treatment might be justified for some of them. If up to three brain metastases are present, surgical resection or radiosurgery are currently being considered in case of favorable prognostic factors. PATIENTS AND METHODS: Retrospective intention-to-treat analysis of 113 patients who underwent whole-brain radiotherapy without surgical resection or radiosurgery at a single institution. Standard treatment was given with ten fractions of 3 Gy. Higher total doses were administered in 13% of patients. Recursive partitioning analysis (RPA) prognostic classes have been described by the Radiation Therapy Oncology Group (RTOG) in 1997 (class I: Karnofsky performance status [KPS] > or = 70%, age < or = 65 years, no extracranial metastases, controlled primary tumor; class III: KPS < 70%; class II: others). RESULTS: Median number of brain metastases was six (four to 50). Most patients (69%) had extracranial metastases as well. Criteria of RPA Class I (II) were met in 4% (41%), whereas 56% had KPS < 70% and thus were grouped into class III (Tables 1 and 2). Complete or partial remission of brain metastases was found in 46% of patients who underwent computed tomography. Median survival was 4 months, 1-years survival rate 15%. Only age was a borderline significant prognostic factor in univariate analysis (< or = 50 years vs > 50 years, p = 0.05). Strong trends were found for KPS, extracranial metastases, control of the primary tumor, and breast primary tumor. Number of brain metastases, RPA class and treatment-related factors such as total dose or remission of brain metastases had no appreciable influence on survival (Figure 1). Multivariate analysis failed to identify any significant prognostic factor. CONCLUSIONS: Patients with four or more brain metastases seem to represent a group with unfavorable prognosis where remission of brain metastases or administration of more than 30 Gy were not associated with increased survival. The number of patients in RPA class I was too small to draw final conclusions. However, there was absolutely no survival difference between patients in class II (median survival 3.6 months) and III (median 4.2 months).     

A simple survival score for patients with brain metastases from breast cancer

Background and purpose

Personalized cancer treatment considers the patient’s survival prognosis. Therefore, it is important to be able to estimate the patient’s survival time, particularly in a palliative situation such as brain metastasis. This study aimed to create and validate a survival score for patients with brain metastasis from breast cancer, which is the second most common primary tumor in these patients.

Patients and methods

Data of 230 patients treated with whole-brain radiotherapy (WBRT) alone for brain metastasis from breast cancer were retrospectively analyzed. Patients were assigned to a test (n?=?115) or a validation group (n?=?115). According to the results of the multivariate analysis of the test group, Karnofsky Performance Score and extracranial metastases were included in the scoring system. The score for each factor was obtained from the 6-month survival rate (in %) divided by 10. Total scores represented the sum of these scores and were 4, 7, 9, or 12 points. Three prognostic groups were formed.

Results

The 6-month survival rates in the test group were 10?% for 4–7 points, 55?% for 9 points, and 78?% for 15 points (p?<?0.001). In the validation group the corresponding 6-month survival rates were 11, 54, and 75?%, respectively (p?<?0.001). The comparisons between the prognostic groups of the test and the validation group did not show significant differences.

Conclusion

This simple survival score appears valid and reproducible. It can be used to estimate the survival time of patients with brain metastasis from breast cancer receiving WBRT alone.