Progression of the lung cancer primary correlates with the identification of new brain metastases after initial radiosurgery |
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Authors: | Jung Ho Han Dong Gyu Kim Chang Wan Oh Chae-Yong Kim Young Hoon Kim Jeong Hoon Park Eun Kyung Kim Hee-Won Jung |
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Institution: | (1) Gamma Knife Center, Department of Neurosurgery, Seoul National University Bundang Hospital, Gyeonggi-do, Korea;(2) Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea;(3) Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehang-ro Jongno-gu, Seoul, 110-744, Korea; |
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Abstract: | We retrospectively evaluated the relationship between the response of lung lesions and distant progression-free survival (DPFS)
after radiosurgery in patients with brain metastases. A total of 47 consecutive patients were treated with radiosurgery for
brain metastases. Distant progression was defined as a new enhancing intracranial tumor or leptomeningeal enhancement noted
on follow-up magnetic resonance imaging. Progression of lung lesions was defined as follows: (1) a 20% increase in the summed
diameter of the target lesions; (2) an absolute increase of 5 mm when the summed diameter was very small; or (3) detection
of new lesions in the lung. Distant progression after radiosurgery was observed for twenty-one (44.7%) patients; we observed
development of new distant metastases in nine patients, development of leptomeningeal seeding in eight patients, and combined
failure of distant progression and local control failure in four patients. Forty-two (89.4%) patients had lung lesions at
the time of radiosurgery, and progression of their lung lesions during the post-radiosurgery follow-up period was observed
for 18 (38.3%) of these. The median DPFS was 7.00 months (95% CI, 6.153–7.847). Actuarial DPFS 3, 6, and 12 months after radiosurgery
was 81.5, 61.3, and 36.7%, respectively. In multivariate analysis, only the criterion progression of lung lesions reached
statistical and independent significance (P = 0.021, OR = 3.372, 95% CI, 1.200–9.480). The response of lung lesions after radiosurgery is likely to be a good predictor
of DPFS after radiosurgery in patients with brain metastases. |
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