Clinicopathologic and Treatment Features of Long-Term Surviving Brain Metastasis Patients
1
Department of Radiation Oncology, University of Toronto, Toronto, ON M5G2M9, Canada
2
Radiation Medicine Program—Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G2M9, Canada
3
Department of Medical Biophysics, University of Toronto, ON M5G2M9, Canada
4
Division of Neurosurgery—Toronto Western Hospital, University of Toronto, Toronto, ON M5G2M9, Canada
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2021, 28(1), 549-559; https://doi.org/10.3390/curroncol28010054
Received: 17 November 2020 / Revised: 20 December 2020 / Accepted: 8 January 2021 / Published: 18 January 2021
Background: The purpose of our study was to characterize clinical features among brain metastasis (BM) patients who were long term survivors (LTS). Methods: We reviewed a registry of BM patients referred to our multidisciplinary BM clinic between 2006 and 2014 and identified 97 who lived ≥ 3 years following BM diagnosis. The clinical and treatment characteristics were obtained from a prospectively maintained database, and additional information was obtained through review of electronic medical records and radiologic images. Survival analyses were performed using the Kaplan-Meier method. Results: Median follow up for LTS was 67 months (range 36–181). Median age was 54 years, 65% had single BM, 39% had stable extracranial disease at the time of BM treatment, and brain was the first site of metastasis in 76%. Targetable mutations were present in 39% of patients and 66% received treatment with targeted-, hormonal-, or immuno-therapy. Brain surgery at the time of diagnosis was performed in 40% and stereotactic radiosurgery (SRS) or whole brain radiotherapy (alone or combination) in 52% and 56%, respectively. Following initial BM treatment, 5-year intracranial disease-free survival was 39%, and the cumulative incidence of symptomatic radio-necrosis was 16%. Five and ten-year overall survival was 72% and 26%, respectively. Conclusion: Most LTS were younger than 60 years old and had a single BM. Many received treatment with surgery or targeted, immune, or hormonal therapy.