Clinicopathologic and Treatment Features of Long-Term Surviving Brain Metastasis Patients
Abstract
:1. Introduction
2. Methods and Materials
2.1. Patient Selection
2.2. Treatment and Follow-up Protocols
2.3. Statistical Analysis
3. Results
3.1. Survival
3.2. Patient Clinical and Treatment Features
3.3. Intracranial Outcomes
3.4. Long-Term Toxicity
4. Discussion
Strength and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Feature | Long-Term Survivors (n = 97) |
---|---|
Age | |
<60 years | 69 (71%) |
60 years or more | 28 (29%) |
Gender | |
Male | 23 (24%) |
Female | 74 (76%) |
ECOG (during diagnosis of BM) | |
0–1 | 73 (75%) |
2 or more | 13 (14%) |
Unknown | 11 (11%) |
Number of intracranial lesions (at time of BM diagnosis) | |
Single | 63 (65%) |
Multiple | 34 (35%) |
Primary | |
Lung | 51 (52%) |
Breast | 24 (25%) |
Thyroid | 6 (7%) |
Melanoma (skin) | 5 (5%) |
Kidney | 3 (3%) |
Unknown primary | 3 (3%) |
Gynecological malignancies | 2 (2%) |
Male genitourinary | 1 (1%) |
Gastrointestinal | 1 (1%) |
Head neck | 1 (1%) |
Extracranial disease status (at the time of BM diagnosis) | |
Controlled | 38 (39%) |
Uncontrolled | 59 (61%) |
Interval from cancer diagnosis to detection of BM | |
Median (range) | 15 (0–266) months |
First site of metastasis | |
Brain | 74 (76%) |
Others | 23 (24%) |
Molecular characteristics | |
Targetable mutations | |
Yes | 38 (39%) |
No | 51 (53%) |
Unknown | 8 (8%) |
Hormonal receptors (among patients with breast cancer) | |
Yes | 16 (67%) |
No | 8 (33%) |
Unknown | 8 (8%) |
Systemic therapy a | |
Targeted therapy/Hormonal therapy/Immune therapy | 64 (66%) |
None of the above/Unknown | 33 (34%) |
Stereotactic radiosurgery a | |
Yes | 50 (52%) |
No | 47 (48%) |
Whole brain radiotherapy a | |
Yes | 54 (56%) |
No | 43 (44%) |
Surgery a | |
Yes | 39 (40%) |
No | 58 (60%) |
Molecular Characteristics | Long-Term Survivors |
---|---|
Lung primary | (n = 51) |
EGFR mutation | 21 (41%) |
ALK rearrangement | 4 (8%) |
EGFR/ALK- | 21 (41%) |
Unknown | 5 (10%) |
Breast primary | (n = 24) |
ER/PR +/Her 2+ | 6 (25%) |
ER/PR+/Her 2- | 10 (42%) |
ER/PR-/Her 2+ | 6 (25%) |
Triple-negative | 2 (8%) |
Unknown | 0 (0%) |
Melanoma | (n = 5) |
BRAF+ | 0 (0%) |
BRAF- | 2 (40%) |
Unknown | 3 (60%) |
Intracranial Treatment | Long-Term Survivors (n = 97) |
---|---|
SRS alone | 29 (30%) |
Surgery alone | 2 (2%) |
WBRT alone | 15 (15%) |
Surgery with SRS | 7 (7%) |
Surgery with WBRT | 25 (26%) |
SRS and WBRT | 9 (9%) |
Surgery with SRS and WBRT | 5 (5%) |
Systemic therapy alone | 5 (5%) |
Study | Cut-off for LTS | No of Patients | Percentage of Patients | Most Common Primary Sites | Patients Receiving WBRT | Patients Receiving SRS | Patients Undergoing Surgery | Crude rate Neurologic Death | Comments/Prognostic Factors |
---|---|---|---|---|---|---|---|---|---|
Hall et al. (2000) [11] | 2 years | 51 | 6.9% (2 years) | 1. NSCLC 2. Breast 3. Melanoma/ renal cell carcinoma | 98% | 8% | 57% | 22% | 1. Ovarian carcinoma patients had the highest rate of survival among cohort. 2. Single lesion, surgery, and WBRT were factors associated with LTS. |
Lutterbach et al. (2002) [12] | 2 years | 2 years-48 3 years-25 5 years-12 | 2.8% (3 years) | 1. NSCLC 2. Breast | 98% | 0% | 73% | NA | 1. For patients with single lesion, radiation boost was considered following WBRT. 2. Survival was best patients with a single brain metastasis |
Kondziolka et al. (2005) [13] | 4 years | 44 | 6.5% a (4 years) | 1. Lung 2. Breast 3. Kidney | 86% | 100% | NA b | 4% | Compared with a cohort of patients surviving < 3 months, LTS had better KPS, fewer metastases, and a lower extracranial disease burden. |
Chao et al. (2006) [14] | 5 years | 32 | 2.5% (5 years) | 1. NSCLC 2. Breast 3. Melanoma | 66% | 28% | 69% | 0% (for 10-year survivors) | 1. Prognostic factors were compared to patients surviving <5 years. 2. Female gender, RPA class 1, surgery, and SRS were associated with better survival. |
Niemiec et al. (2011) [15] | 3 years | 19 | 2% c | NSCLC | 79% | 32% | 53% | 33% | 1. Compared with control group of patients with brain metastases from lung cancer. 2. Female sex, RPA class 1, adenocarcinoma, control of primary tumour and no extracranial metastasis was associated with LTS. |
Enders et al. (2016) [16] | 2 years | 21 | 18% | NSCLC | 81% | 0% | 100% | NR | Surgery for primary tumour was the only significant factor associated with LTS. |
Kotecha et al. (2016) [17] | 10 years | 5 years-56 10 yrs-23 | 1.2% (10 years) | 1. NSCLC 2. Melanoma 3. Breast/unknown primary | 52% | 30% | 70% | 0% (for 10-year survivors) | Female gender, single brain metastasis and SRS were associated with better overall survival |
Current study (2020) | 3 years | 3 years-97 5 years-64 | 16% (5 years) | 1. NSCLC 2. Breast 3. Thyroid | 56% | 52% | 40% | 36% d | 71% of the LTS were <60 years, 65% had single BM at the time of diagnosis, 76% had brain as the first site of metastatic disease, 39% had targetable mutations, 66% received targeted/hormonal and immunotherapies. |
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Dasgupta, A.; Co, J.; Winter, J.; Millar, B.-A.; Laperriere, N.; Tsang, D.S.; van Prooijen, M.; Damyanovich, A.; Heaton, R.; Coolens, C.; et al. Clinicopathologic and Treatment Features of Long-Term Surviving Brain Metastasis Patients. Curr. Oncol. 2021, 28, 549-559. https://doi.org/10.3390/curroncol28010054
Dasgupta A, Co J, Winter J, Millar B-A, Laperriere N, Tsang DS, van Prooijen M, Damyanovich A, Heaton R, Coolens C, et al. Clinicopathologic and Treatment Features of Long-Term Surviving Brain Metastasis Patients. Current Oncology. 2021; 28(1):549-559. https://doi.org/10.3390/curroncol28010054
Chicago/Turabian StyleDasgupta, Archya, Jayson Co, Jeff Winter, Barbara-Ann Millar, Normand Laperriere, Derek S. Tsang, Monique van Prooijen, Andrei Damyanovich, Robert Heaton, Catherine Coolens, and et al. 2021. "Clinicopathologic and Treatment Features of Long-Term Surviving Brain Metastasis Patients" Current Oncology 28, no. 1: 549-559. https://doi.org/10.3390/curroncol28010054
APA StyleDasgupta, A., Co, J., Winter, J., Millar, B.-A., Laperriere, N., Tsang, D. S., van Prooijen, M., Damyanovich, A., Heaton, R., Coolens, C., Bernstein, M., Kongkham, P., Zadeh, G., Berlin, A., Conrad, T., Moraes, F. Y., & Shultz, D. B. (2021). Clinicopathologic and Treatment Features of Long-Term Surviving Brain Metastasis Patients. Current Oncology, 28(1), 549-559. https://doi.org/10.3390/curroncol28010054