scholarly journals Brain Metastases from Gynecological Cancers: Factors that Affect Overall Survival

2002 ◽  
Vol 1 (4) ◽  
pp. 305-310 ◽  
Author(s):  
Ashraf S. Mahmoud-Ahmed ◽  
Patrick A. Kupelian ◽  
Chandana A. Reddy ◽  
John H. Suh
Keyword(s):  
Overall Survival ◽  
Brain Metastases ◽  
Focal Therapy ◽  
Tumor Characteristics ◽  
Gynecological Cancers ◽  
Whole Brain Radiation ◽  
Improved Outcomes ◽  
Brain Radiation ◽  
The Brain ◽  
Single Lesion

We retrospectively reviewed factors that affected overall survival for patients with gynecological cancers that had metastasized to the brain. Between January 1985 to November 1999, we treated 25 patients with brain metastases from gynecological malignancies (cervix n=6, endometrium n=10, and ovary n=9). Various patient and tumor characteristics were identified and analyzed for their significance. Median age was 46 years old (range, 37–78 years) with the majority of tumors being adenocarcinoma (20/25 patients). The treatment consisted of whole brain radiation therapy (WBRT) in 11 patients, focal therapy (surgery and/or stereotactic radiosurgery [SRS]) in 6 patients, and combination therapy (WBRT and surgery and/or SRS) in 8 patients and resulted in median survivals of 6 months, 7 months and 11 months, respectively. Overall median survival was 7.3 months (range, 1 to 88 months). Cause of death was systemic in 9, neurologic in 8 and progression of primary in 2. Those with single lesions had better median survivals compared to those with multiple lesions (17 months vs. 3 months, p=0.017). Our results suggest that patients with a single lesion had improved outcomes. We encourage enrollment of patients with brain metastases onto prospective clinical trials.

scholarly journals Outcome comparison of patients who develop leptomeningeal disease or distant brain recurrence after brain metastases resection cavity radiosurgery

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Achiraya Teyateeti ◽  
Paul D Brown ◽  
Anita Mahajan ◽  
Nadia N Laack ◽  
Bruce E Pollock
Keyword(s):  
Overall Survival ◽  
Brain Metastases ◽  
Median Overall Survival ◽  
Recursive Partitioning ◽  
Leptomeningeal Disease ◽  
Resection Cavity ◽  
Whole Brain Radiation ◽  
Class 1 ◽  
Outcome Comparison ◽  
Brain Radiation

Abstract Background To compare the outcomes between patients with leptomeningeal disease (LMD) and distant brain recurrence (DBR) after stereotactic radiosurgery (SRS) brain metastases (BM) resection cavity. Methods Twenty-nine patients having single-fraction SRS after BM resection who developed either LMD (n = 11) or DBR (n = 18) as their initial and only site of intracranial progression were retrospectively reviewed. Results Patients developing LMD more commonly had a metachronous presentation (91% vs 50%, P = .04) and recursive partitioning class 1 status (45% vs 6%, P = .02). There was no difference in the median time from SRS to the development of LMD or DBR (5.0 vs 3.8 months, P = .68). The majority of patients with LMD (10/11, 91%) developed the nodular variant (nLMD). Treatment for LMD was repeat SRS (n = 4), whole-brain radiation therapy (WBRT; n = 5), resection + WBRT (n = 1), and no treatment (n = 1). Treatment for DBR was repeat SRS (n = 9), WBRT (n = 3), resection + resection cavity SRS (n = 1), and no treatment (n = 5). Median overall survival (OS) from time of resection cavity SRS was 15.7 months in the LMD group and 12.7 months in the DBR group (P = .60), respectively. Median OS in salvage SRS and salvage WBRT were 25.4 and 5.0 months in the nLMD group (P = .004) while 18.7 and 16.2 months in the DBR group (P = .30), respectively. Conclusions Following BM resection cavity SRS, nLMD recurrence is much more frequent than classical LMD. Salvage SRS may be considered for selected patients with nLMD, reserving salvage WBRT for patients with extensive intracranial disease without compromising survival. Further study with larger numbers of patients is needed.

scholarly journals The Rationale for Adjuvant Whole Brain Radiation Therapy with Radiosurgery in the Treatment of Single Brain Metastases

2003 ◽  
Vol 2 (2) ◽  
pp. 111-115 ◽  
Author(s):  
Roy A. Patchell ◽  
William F. Regine
Keyword(s):  
Radiation Therapy ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Scientific Evidence ◽  
Focal Therapy ◽  
Whole Brain Radiation Therapy ◽  
Conventional Surgery ◽  
Whole Brain ◽  
Whole Brain Radiation ◽  
Brain Radiation

Randomized trials have established the efficacy of focal treatment (either stereotactic radiosurgery or conventional surgery) for single brain metastases. In the past, adjuvant whole brain radiation therapy (WBRT) was routinely given with focal therapy. Recently, the utility of adjuvant WBRT has been called into question. This paper examines the scientific evidence and the arguments, pro and con, concerning the use of adjuvant WBRT in association with stereotactic radiosurgery or conventional surgery.

The Role of Radiosurgery to the Tumor Bed After Resection of Brain Metastases

Neurosurgery ◽  
2012 ◽  
Vol 72 (3) ◽  
pp. 317-326 ◽  
Author(s):  
Jared H. Gans ◽  
Daniel M.S. Raper ◽  
Ashish H. Shah ◽  
Amade Bregy ◽  
Deborah Heros ◽  
...  
Keyword(s):  
Systematic Review ◽  
Overall Survival ◽  
Radiation Therapy ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Local Control ◽  
Total Resection ◽  
Whole Brain Radiation ◽  
Brain Radiation

Abstract BACKGROUND: Optimal postoperative management paradigm for brain metastases remains controversial. OBJECTIVE: To conduct a systematic review of the literature to understand the role of postoperative stereotactic radiosurgery after resection of brain metastases. METHODS: We performed a MEDLINE search of the literature to identify series of patients with brain metastases treated with stereotactic radiosurgery after surgical resection. Outcomes including overall survival, local control, distant intracranial failure, and salvage therapy use were recorded. Patient, tumor, and treatment factors were correlated with outcomes through the use of the Pearson correlation and 2-way Student t test as appropriate. RESULTS: Fourteen studies involving 629 patients were included. Median survival for all studies was 14 months. Local control was correlated with the median volume treated with radiosurgery (r = −0.766, P < .05) and with the rate of gross total resection (r = .728, P < .03). Mean crude local control was 83%; 1-year local control was 85%. Distant intracranial failure occurred in 49% of cases, and salvage whole-brain radiation therapy was required in 29% of cases. Use of a radiosurgical margin did not lead to increased local control or overall survival. CONCLUSION: Our systematic review supports the use of radiosurgery as a safe and effective strategy for adjuvant treatment of brain metastases, particularly when gross total resection has been achieved. With all limitations of comparisons between studies, no increase in local recurrence or decrease in overall survival compared with rates with adjuvant whole-brain radiation therapy was found.

scholarly journals NCOG-05. MANAGEMENT OF BRAIN METASTASIS IN TRIPLE NEGATIVE BREAST CANCER

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii130-ii130
Author(s):  
Ravi Medikonda ◽  
Siddhartha Srivastava ◽  
Timothy Kim ◽  
Yuanxuan Xia ◽  
Mira Patel ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Radiation Therapy ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Triple Negative Breast Cancer ◽  
Triple Negative ◽  
Whole Brain ◽  
Whole Brain Radiation ◽  
Brain Radiation

Abstract Brain metastasis is common in patients with breast cancer, and those with triple negative status have an even higher risk. Stereotactic radiosurgery (SRS) is preferred to whole brain radiation therapy (WBRT) in most patients. However, triple negative status is currently not considered when determining optimal radiation therapy. Given the aggressive nature of triple negative breast cancer, we evaluated a role for WBRT for all patients in this cohort. We conducted a single-institution retrospective cohort study to determine whether triple negative patients with brain metastases have a higher burden of intracranial disease and whether type of initial radiation therapy affects overall survival for this cohort of patients. 85 patients met the inclusion criteria for this study. 25% of patients had triple negative breast cancer, of which 91% received SRS and 53% of patients received WBRT. The average number of new brain metastases from time of initial brain imaging to radiation therapy was 0.67 (St.Dev:1.1) in the non-triple negative status patients and 2.6 (St. Dev:3.7) in the triple negative status patients (p=0.001). Using a cox proportional hazards model, it was found that whole brain radiotherapy does not significantly affect overall survival in patients with triple negative breast cancer (p = 0.96). Our findings highlight the highly aggressive intracranial nature of triple negative breast cancer. Indeed, the rate of increase in brain metastases is significantly higher for triple negative patients compared to non-triple negative patients. As a result, we evaluated whether triple negative patients would benefit from whole brain radiation regardless of findings on initial brain imaging. Despite 53% of patients receiving WBRT, our investigation found that there is no additional benefit to WBRT in triple negative breast cancer patients. These results suggest a need to re-evaluate the role of WBRT in the management of triple negative breast cancer.

Pejorative factors identification for survival in patients with brain metastases from breast carcinoma treated with whole brain radiation therapy

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 10513-10513
Author(s):  
R. Le Scodan ◽  
C. Massard ◽  
E. Fourme ◽  
J. Guinebretiere ◽  
A. Goupil ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Radiation Therapy ◽  
Prognostic Factors ◽  
Breast Carcinoma ◽  
Brain Metastases ◽  
Whole Brain ◽  
Whole Brain Radiation ◽  
Her 2 ◽  
Brain Radiation

10513 Background: To determine overall survival and independent prognostic factors for patients with brain metastases from breast carcinoma treated with whole brain radiation therapy (WBRT). Methods: From January 1998 through December 2003, 132 patients with brain metastases (BM) from breast carcinoma were treated with WBRT (median dose: 3000 cGy/ 10 fractions). We analyzed a number of potential predictors of survival after WBRT: age, presence of other systemic metastases, performance status, RTOG recursive partition analysis (RPA) class (1–2 vs 3), total dose of WBRT, number of brain metastases, interval between primary tumor and brain metastases, SBR score, tumor receptor hormonal (RH) status, lymphocyte count (< 700 vs ≥ 700 G/L), serum lactate dehydrogenase and HER-2 overexpression. The survival time with BM was defined as the time from the date of BM to the date of death or date of last of follow-up. Multivariate analysis was used to determine the effect of prognostic factors on overall survival using the Cox proportional hazard model. Results: One hundred and seventeen patients received exclusive WBRT. Surgery was followed by WBRT in 14 patients and stereotactic radiosurgery was followed by WBRT in 1. The median survival with BM was 6 months (range: 0–52). The 1-year and 2-years survival rates were 31% (CI95%: 23.5–39.8) and 16% (CI95%: 9.8–24.9). In multivariate analysis, RTOG RPA class III, lymphopenia (<700) and negative tumor RH status were independent prognostic factors for poor survival. Moreover, analysis of Her-2 overexpression was performed in 53 patients and 43% BM patients overexpressed Her-2. In preliminary analysis, Her-2 status was not a prognostic factor of survival. A complete analysis is ongoing and will be presented at the meeting. Conclusions: This large study confirms the value of established prognostic factors such as the RTOG RPA score and some less-well recognized factors such as lymphopenia and tumor RH status. No significant financial relationships to disclose.

Results of Whole Brain Radiation Therapy in Patients with Brain Metastases from Colorectal Carcinoma

2005 ◽  
Vol 91 (2) ◽  
pp. 163-167 ◽  
Author(s):  
Maurizio Amichetti ◽  
Giancarlo Lay ◽  
Marina Dessì ◽  
Silvia Orrù ◽  
Roberta Farigu ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Radiation Therapy ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Survival Time ◽  
Whole Brain Radiation Therapy ◽  
Whole Brain ◽  
Whole Brain Radiation ◽  
Brain Radiation ◽  
The Brain

Aims and background Carcinoma of the colon-rectum is an infrequent cause of brain metastases, constituting 1-5% of all metastatic lesions to the brain. We reviewed our experience in the treatment of brain metastases from colorectal cancer to define the efficacy of whole brain radiation therapy as a palliative measure in this setting of patients. Methods Twenty-three consecutive cases of brain metastasis from colorectal cancer treated between 1999 and 2004 were identified in the files of the Division of Radiotherapy of the A Businco Regional Oncological Hospital, Cagliari. Their records were reviewed for patient and tumor characteristics and categorized according to the RTOG RPA classes. Results Fifteen patients (65%) had multiple metastases. Twenty-one patients (91%) showed extracranial metastases. Fourteen patients were classified as RTOG RPA class II and 9 class III. The median radiation dose delivered was 2000 cGy in 5 fractions in one week (range, 20-36 Gy). In 14 of 20 assessable patients (70%), symptomatic improvement was observed. The median follow-up and survival time for all the patients, 12 females and 11 males, was 3 months. In 3 patients only the cause of death was the brain metastasis. Conclusions Despite the disappointing survival time, external radiation therapy to the whole brain proved to be an efficacious palliative treatment for patients with multiple or inoperable brain metastasis from colorectal cancer.

scholarly journals A Prospective Phase II Trial of Fractionated Stereotactic Intensity Modulated Radiotherapy With or Without Surgery in the Treatment of Patients With 1 to 3 Newly Diagnosed Symptomatic Brain Metastases

Neurosurgery ◽  
2014 ◽  
Vol 74 (6) ◽  
pp. 586-594 ◽  
Author(s):  
Mario Ammirati ◽  
Varun R. Kshettry ◽  
Tariq Lamki ◽  
Lai Wei ◽  
John C. Grecula
Keyword(s):  
Overall Survival ◽  
Confidence Interval ◽  
Brain Metastases ◽  
Phase Ii ◽  
Progression Free Survival ◽  
Newly Diagnosed ◽  
Free Survival ◽  
Intensity Modulated ◽  
Whole Brain Radiation ◽  
Brain Radiation

ABSTRACT BACKGROUND: Several studies have demonstrated that omitting the routine use of adjuvant whole-brain radiation therapy for patients with newly diagnosed brain metastases may be a reasonable first-line strategy. Retrospective evidence suggests that fractionated stereotactic radiotherapy (fSRT) may have a lower level of toxicity with equivalent efficacy in comparison with radiosurgery. OBJECTIVE: To study the phase II efficacy of using a focally directed treatment strategy for symptomatic brain metastases by the use of fSRT with or without surgery and omitting the routine use of adjuvant whole-brain radiation therapy. METHODS: We used a Fleming single-stage design of 40 patients. Patients were eligible if they presented with 1 to 3 newly diagnosed symptomatic brain metastases, Karnofsky performance scale (KPS) greater than 60, and histological confirmation of primary disease. Patients underwent fSRT with the use of a dose of 30 Gy in 5 intensity-modulated fractions as primary or adjuvant treatment after surgical resection. The primary end point was the proportion of patients who experienced neurological death. Secondary end points were overall survival, time to KPS &lt;70, and progression-free survival. RESULTS: Of 40 patients accrued, 39 were eligible for analysis. The proportion of patients dying of neurological causes was 13% (5 patients), which includes 3 patients with an unknown cause of death. Median overall survival, time to KPS &lt;70, and progression-free survival were 16 (95% confidence interval, 9-23), 14 (95% confidence interval, 7-20), and 11 (95% confidence interval, 4-21) months, respectively. CONCLUSION: A focally directed treatment strategy using fSRT with or without surgery appears to be an effective initial strategy. Based on the results of this phase II clinical trial, further study is warranted.

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