scholarly journals High neutrophil, low lymphocyte and hemoglobin unfavorably impact survival in non-small cell lung cancer patients with brain metastases

2020 ◽  
Author(s):  
Wang Li ◽  
Yanli Qu ◽  
Fengyun Wen ◽  
Xiaoyi He ◽  
Hongying Jia ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Cox Regression ◽  
Characteristic Curve ◽  
Whole Brain Radiotherapy ◽  
Clinical Problem ◽  
Cox Regression Analysis ◽  
Brain Radiotherapy ◽  
History Of ◽  
Hematological Indicators ◽  
Nsclc Patients

Abstract Background Brain metastases (BM) from NSCLC has emerged as an increasingly corresponding clinical problem. Precise prognostic evaluation is the basis for personalized medicine. This study sought to investigate prognostic values of clinical and hematological indicators for NSCLC patients with BM in the real world, which could further help guide survivorship care in the actual clinical setting and clinical trials. Materials and Methods We retrospectively reviewed the clinical and hematological indicators of NSCLC patients with BM treated with whole-brain radiotherapy. Receiver operating characteristic curve was performed to evaluate the optimal cut-off point. Kaplan–Meier survival analysis and Cox regression analyses were used to evaluate survival. Results 105 patients were included and median survival was 21 months (range: 1–64 months). Univariate analyses demonstrated that favorable survival was associated with resection history of NSCLC (P = 0.015), absent of intracranial symptom (P = 0.044), lymphocyte ≥ 1.54*109/L(P < 0.001), neutrophil < 4.64*109/L (P = 0.016), hemoglobin ≥ 117.5 g/L (P < 0.001), BSBM scores of 2–3 (P = 0.033) and Lung-molGPA scores of 2.5-4 (P < 0.001). Cox regression analysis showed that lymphocyte (HR 3.390, 95% CI 1.869–6.151, P < 0.001), neutrophil (HR 0.517, 95% CI 0.286–0.934, P = 0.029), hemoglobin (HR 3.215, 95% CI 1.748–5.911, P < 0.001), resection history of NSCLC(HR 2.813, 95% CI 1.375–5.754, P = 0.005), intracranial symptom(HR 0.251, 95% CI 0.113–0.561, P = 0.001), and Lung-molGPA(HR 2.317, 95% CI 1.186–4.527, P = 0.014) were independent prognostic factors for NSCLC patients with BM. Conclusions High neutrophil, low lymphocyte and hemoglobin, absent of resection history of NSCLC, present of intracranial symptom, and Lung-molGPA scores of 0–2 may provide valuable information for indicating poor prognosis in NSCLC patients with BM .

scholarly journals Whole Brain Radiotherapy With and Without Concurrent Erlotinib in NSCLC with Brain Metastases: a multicentre, open-label, randomized, controlled phase 3 Trial

2020 ◽  
Author(s):  
Zhenzhou Yang ◽  
Yan Zhang ◽  
Rongqing Li ◽  
Abulimiti Yisikandaer ◽  
Biyong Ren ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Objective Response ◽  
Whole Brain Radiotherapy ◽  
Combination Group ◽  
Open Label ◽  
Phase 3 ◽  
Whole Brain ◽  
Brain Radiotherapy ◽  
Egfr Mutant ◽  
Nsclc Patients

Abstract Background Erlotinib combined with whole brain radiotherapy (WBRT) demonstrated a favorable objective response rate in a phase 2 single-arm trial of non-small cell lung cancer (NSCLC) patients with brain metastases. We assessed whether concurrent erlotinib with WBRT is safe and benefits patients in a phase 3, randomized trial. Methods NSCLC patients with two or more brain metastases were enrolled and randomly assigned (1:1) to WBRT (n=115) or WBRT combined with erlotinib arms (n=109). The primary endpoint was intracranial progression-free survival (iPFS) and cognitive function (CF) was assessed by Mini–Mental State Examination (MMSE). Results A total of 224 patients from 10 centers across China were randomized to treatments. Median follow-up was 11.2 months. Median iPFS for WBRT concurrent erlotinib was 11.2 months versus 9.2 months for WBRT-alone (p=0.601). Median PFS and overall survival (OS) of combination group were 5.3 versus 4.0 months (p=0.825) and 12.9 versus 10.0 months (p=0.545), respectively, compared with WBRT-alone. In EGFR-mutant patients, iPFS (14.6 versus 12.8 months; p=0.164), PFS (8.8 versus 6.4 months; p=0.702) and OS (17.5 versus 16.9 months; p=0.221) were not significantly improved in combination group over WBRT-alone. Moreover, there were no significant differences in patients experiencing MMSE score change between the treatments. Conclusion Concurrent erlotinib with WBRT didn’t improve iPFS and excessive CF detriment either in the intent-to-treat (ITT) population or in EGFR-mutant patients compared with WBRT-alone, suggesting that while safe for patients already taking the drug, there is no justification for adding concurrent EGFR-TKI with WBRT for the treatment of brain metastases.

scholarly journals Success of Crizotinib Combined with Whole-Brain Radiotherapy for Brain Metastases in a Patient with Anaplastic Lymphoma Kinase Rearrangement-Positive Non-Small-Cell Lung Cancer

2018 ◽  
Vol 11 (3) ◽  
pp. 777-783 ◽  
Author(s):  
Sachi Okawa ◽  
Takuo Shibayama ◽  
Atsushi Shimonishi ◽  
Jun Nishimura ◽  
Taichi Ozeki ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Brain Metastases ◽  
Anaplastic Lymphoma Kinase ◽  
Whole Brain Radiotherapy ◽  
Small Cell ◽  
Small Cell Lung ◽  
Alk Rearrangement ◽  
Anaplastic Lymphoma ◽  
Brain Radiotherapy ◽  
Nsclc Patients

Although crizotinib shows marked antitumor activity in anaplastic lymphoma kinase (ALK) rearrangement-positive non-small-cell lung cancer (NSCLC) patients, all treated patients ultimately develop resistance to this drug. Isolated central nervous system failure without progression at extracranial sites is a common progression pattern in ALK rearrangement-positive NSCLC patients treated with crizotinib. Here, we report the success of crizotinib combined with whole-brain radiotherapy in an ALK rearrangement-positive NSCLC patient who developed leptomeningeal carcinomatosis and progression of multiple brain metastases. Additionally, we focused on the mechanism involved by examining the plasma and cerebrospinal fluid concentrations of crizotinib in the present case.

Primary chemotherapy, stereotactic radiosurgery, or whole brain radiotherapy in non-small cell lung cancer (NSCLC) patients with asymptomatic brain metastases

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e19063-e19063
Author(s):  
K. Kim ◽  
J. Lee ◽  
M. Chang ◽  
J. Uhm ◽  
J. A. Yun ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Whole Brain Radiotherapy ◽  
Progression Free Survival ◽  
Primary Chemotherapy ◽  
Treatment Modalities ◽  
Whole Brain ◽  
Brain Radiotherapy ◽  
Nsclc Patients

e19063 Background: Approximately 25 to 30% of patients with lung cancer develop brain metastases at some stage and 12∼18% at the time of initial presentation. Whole brain radiotherapy (WBRT) has long been a mainstay of treatment of brain metastases. Another treatment approach, Stereotactic radiosurgery (SRS) is a method of delivering high doses of focal irradiation to a tumor while minimizing the irradiation to the adjacent normal tissue. However, the prognosis of NSCLC patients with asymptomatic brain metastases, who are not treated with SRS or WBRT, has not been fully investigated yet. This study aimed to analyze the outcome for various treatment modalities in NSCLC patients with asymptomatic brain metastases. Methods: We reviewed the medical records of 129 patients with a histopathologically proven NSCLC and a synchronous brain metastases between January 2003 and December 2007. The patients were categorized as primary chemotherapy, primary SRS, and primary WBRT group: primary chemotherapy (78 patients), primary SRS (24 patients), and primary WBRT (27 patients). Results: With median follow-up of 30.0 months (7.2 -70.7), the median overall survival (OS) for the entire patients was 15.6 months (0.5–50.7) and the progression free survival (PFS) was 6.1 months (0.3- 53.0). The OS was 22.4m for primary SRS group, 13.9m for primary chemotherapy group, and 17.7m for primary WBRT group; p=0.86). However, patients treated with primary SRS showed trend toward prolonged survival compared to those of primary WBRT p=0.06). Subset analysis of 110 adenocarcinoma patients showed that the median OS for patients treated with primary SRS was longer than those of primary WRBT (29.3m vs 17.7m p=0.01) or primary chemotherapy (29.3m vs 14.6m p=0.04). Conclusions: These results suggest that for NSCLC patients with asymptomatic brain metastases at first diagnosis, SRS rather than primary chemotherapy or WBRT might be considered as initial treatment, especially for patients with adenocarcinoma. No significant financial relationships to disclose.

scholarly journals Randomized Trial of Erlotinib Plus Whole-Brain Radiotherapy for NSCLC Patients With Multiple Brain Metastases

2014 ◽  
Vol 106 (7) ◽  
Author(s):  
Siow Ming Lee ◽  
Conrad R. Lewanski ◽  
Nicholas Counsell ◽  
Christian Ottensmeier ◽  
Andrew Bates ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Randomized Trial ◽  
Whole Brain Radiotherapy ◽  
Whole Brain ◽  
Multiple Brain Metastases ◽  
Brain Radiotherapy ◽  
Nsclc Patients

scholarly journals Effect of xenon on pain severity and adaptational status of neuro-oncological and oncogynecological patients

2019 ◽  
Vol 19 (1S) ◽  
pp. 228-230 ◽  
Author(s):  
N N Popova ◽  
M S Zinkovich ◽  
A I Shikhlyarova ◽  
G V Zhukova ◽  
L Ya Rozenko ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Visual Analogue Scale ◽  
Brain Metastases ◽  
Radical Hysterectomy ◽  
Analgesic Effect ◽  
Analogue Scale ◽  
Whole Brain Radiotherapy ◽  
The Body ◽  
Brain Radiotherapy ◽  
Hematological Indicators

The severity of pain and changes in the adaptational status were studied in patients with brain metastases or cervical cancer receiving xenon therapy after whole brain radiotherapy or after radical hysterectomy. Hematological indicators of the nature and tensiton of general nonspecific adaptional reactions of the body (ARs) by Garkavi-Kvakina-Ukolova, the QLQ-C15 questionnaire and a 10-point graphic visual analogue scale for the assessment of the intensity of pain were used. Xenon caused concurrent reduce in the intensity of pain and improvement of characteristics of ARs in all studied patients. The results suggested an association between the analgesic effect of xenon and the normalization of neuroimmune processes and reduced damaging effects of special antitumor treatment on the body under the influence of xenon.

Identification of prognostic factors in patients with brain metastases: A review of 493 patients

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 11516-11516
Author(s):  
B. P. Baltalarli ◽  
D. Yalman ◽  
O. Akagündüz ◽  
Z. Ozsaran ◽  
Y. Anacak ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Whole Brain Radiotherapy ◽  
Late Toxicity ◽  
Female Gender ◽  
University Hospital ◽  
Rank Test ◽  
Brain Radiotherapy ◽  
Selection Of

11516 Background: Choice of treatment for an individual patient with brain metastases is based on a number of factors: number and localization of brain metastases, systemic tumor activity, performance score, and age are major determinants for selection of treatment modality. Future trials in patients with brain metastases depend on selection of patients with favorable prognosis to allow adequate long-term follow-up to draw conclusions about survival and late toxicity, further stressing the importance of prognostic parameters. Our aim is to report the outcome of patients with brain metastases from solid tumors treated with whole brain radiotherapy (WBRT) in a single institution and identify the prognostic subgroups who will benefit from treatment. Methods: The records of 493 patients with brain metastases who had been admitted for WBRT in the Department of Radiation Oncology in Ege University Hospital between January 1997 and December 2002 was retrospectively evaluated. WBRT at this institution comprised of parallel opposed lateral fields, dosed to the midplane in a cobalt 60 teletherapy device. Radiotherapy fractionation were 10 fr. × 3 Gy, 5 fr × 4 Gy and 2 fr. × 8 Gy. Survival was calculated using the Kaplan-Meier method. Cox regression modeling was used for multivariate analysis and prognostical factors were determined on the basis of log rank test (SPSS 10.00 version). Results: Clinical response evaluation revealed that 254 patients (51%) had response to tretament whereas 104 patients (21.1%) had stable response and the other 43 patients (8.7%) had progressive disease.The median survival was 3 months (1–62 months) and 6 months survival was 41% and one year survival was 19%. Univariate analysis revealed that prognostical factors for survival were younger age (age <57) (p=0.043), female gender (p=0.019) and operation (p=0.0004), and for multivariant analysis female gender (p=0.027) and operation were determined (p=0.000). Conclusion: The prognosticators for survival in this retrospective analysis for patients with brain metastases are age, gender and operation. These factors affecting survival must be taken into consideration when the therapeutic management is to be made. And they may allow better selection of individual treatments. No significant financial relationships to disclose.

scholarly journals Immune checkpoint inhibition in patients treated with stereotactic radiation for brain metastases

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Emily S. Kowalski ◽  
Jill S. Remick ◽  
Kai Sun ◽  
Gregory S. Alexander ◽  
Rahul Khairnar ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Local Control ◽  
Immune Checkpoint ◽  
Cox Regression ◽  
Radiation Necrosis ◽  
Stereotactic Radiation ◽  
Cox Regression Analysis ◽  
Increased Risk ◽  
Nsclc Patients ◽  
The Impact

Abstract Purpose Stereotactic radiation therapy (SRT) and immune checkpoint inhibitors (ICI) may act synergistically to improve treatment outcomes but may also increase the risk of symptomatic radiation necrosis (RN). The objective of this study was to compare outcomes for patients undergoing SRT with and without concurrent ICI. Methods and materials Patients treated for BMs with single or multi-fraction SRT were retrospectively reviewed. Concurrent ICI with SRT (SRT-ICI) was defined as administration within 3 months of SRT. Local control (LC), radiation necrosis (RN) risk and distant brain failure (DBF) were estimated by the Kaplan-Meier method and compared between groups using the log-rank test. Wilcoxon rank sum and Chi-square tests were used to compare covariates. Multivariate cox regression analysis (MVA) was performed. Results One hundred seventy-nine patients treated with SRT for 385 brain lesions were included; 36 patients with 99 lesions received SRT-ICI. Median follow up was 10.3 months (SRT alone) and 7.7 months (SRT- ICI) (p = 0.08). Lesions treated with SRT-ICI were more commonly squamous histology (17% vs 8%) melanoma (20% vs 2%) or renal cell carcinoma (8% vs 6%), (p < 0.001). Non-small cell lung cancer (NSCLC) compromised 60% of patients receiving ICI (n = 59). Lesions treated with SRT-ICI had significantly improved 1-year local control compared to SRT alone (98 and 89.5%, respectively (p = 0.0078). On subset analysis of NSCLC patients alone, ICI was also associated with improved 1 year local control (100% vs. 90.1%) (p = 0.018). On MVA, only tumor size ≤2 cm was significantly associated with LC (HR 0.38, p = 0.02), whereas the HR for concurrent ICI with SRS was 0.26 (p = 0.08). One year DBF (41% vs. 53%; p = 0.21), OS (58% vs. 56%; p = 0.79) and RN incidence (7% vs. 4%; p = 0.25) were similar for SRT alone versus SRT-ICI, for the population as a whole and those patients with NSCLC. Conclusion These results suggest SRT-ICI may improve local control of brain metastases and is not associated with an increased risk of symptomatic radiation necrosis in a cohort of predominantly NSCLC patients. Larger, prospective studies are necessary to validate these findings and better elucidate the impact of SRT-ICI on other disease outcomes.

scholarly journals The Infratentorial Localization of Brain Metastases May Correlate with Specific Clinical Characteristics and Portend Worse Outcomes Based on Voxel-Wise Mapping

Cancers ◽  
2021 ◽  
Vol 13 (2) ◽  
pp. 324
Author(s):  
Zhangqi Dou ◽  
Jiawei Wu ◽  
Hemmings Wu ◽  
Qian Yu ◽  
Feng Yan ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Clinical Characteristics ◽  
Cox Regression ◽  
Whole Brain Radiotherapy ◽  
Ki 67 ◽  
Brain Radiotherapy ◽  
Kaplan Meier ◽  
Radiotherapy Alone ◽  
Prognostic Prediction ◽  
Occipital Lobes

The infratentorial regions are vulnerable to develop brain metastases (BMs). However, the associations between the infratentorial localization of BMs and clinical characteristics remained unclear. We retrospectively studied 1102 patients with 4365 BM lesions. Voxel-wise mapping of MRI was applied to construct the tumor frequency heatmaps after normalization and segmentation. The analysis of differential involvement (ADIFFI) was further used to obtain statistically significant clusters. Kaplan-Meier method and Cox regression were used to analyze the prognosis. The parietal, insular and left occipital lobes, and cerebellum were vulnerable to BMs with high relative metastatic risks. Infratentorial areas were site-specifically affected by the lung, breast, and colorectal cancer BMs, but inversely avoided by melanoma BMs. Significant infratentorial clusters were associated with young age, male sex, lung neuroendocrine and squamous cell carcinomas, high expression of Ki-67 of primaries and BMs, and patients with poorer prognosis. Inferior OS was observed in patients with ≥3 BMs and those who received whole-brain radiotherapy alone. Infratentorial involvement of BMs was an independent risk factor of poor prognosis for patients who received surgery (p = 0.023, hazard ratio = 1.473, 95% confidence interval = 1.055–2.058). The current study may add valuable clinical recognition of BMs and provide references for BMs diagnosis, treatment evaluation, and prognostic prediction.

Recurrent Brain Metastases: The Role of Resection of in the Era of Molecular Medicine

2021 ◽  
Author(s):  
Nadine Hessler ◽  
Stephanie T Jünger ◽  
Anna-Katharina Meissner ◽  
Martin kocher ◽  
Roland H Goldbrunner ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Surgical Resection ◽  
Complication Rate ◽  
Cox Regression ◽  
Clinical Status ◽  
Whole Brain Radiotherapy ◽  
Molecular Medicine ◽  
Karnofsky Performance Score ◽  
Primary Tumors ◽  
Cox Regression Analysis

Abstract Purpose To evaluate the efficacy of surgical resection for pretreated, recurrent brain metastases (BM) in the era of molecular oncologic medicine. Patients and Methods: In a retrospective single center study, patients were analyzed who had undergone surgical resection of recurrent BM between 2007 and 2019. Intracranial event-free survival (EFS) and overall survival (OS) were evaluated by Kaplan-Maier and Cox regression analysis. Results In total, 107 patients with different primary tumor entities and individual previous treatment for BM were included. Primary tumors comprised non-small cell lung cancer (NSCLC) (37.4%), breast cancer (19.6%), melanoma (13.1%), gastro-intestinal cancer (10.3%) and other, rare entities (19.6%). The number of previous treatments of BM ranged from one to four; these comprised: resection only, focal or whole brain radiotherapy, brachytherapy and radiosurgery. BM-related symptoms were present in 73.8% of the patients. Median pre-operative Karnofsky Performance Score (KPS) was 70% (range 40–100) which was improved to 80% (range 0-100) after surgery. The complication rate was 26.2% and two patients died during the perioperative period. Postoperative local radio-oncologic and/or systemic therapy regimens were applied in 67 (62.6%) patients. Median postoperative EFS and OS were 7.1 (95%CI 5.8–8.2) and 11.1 (95%CI 8.4–13.6) months, respectively. The clinical status (postoperative KPS ≥ 70 (HR 0.27 95%CI 0.16–0.46; p < 0.001) remained the only independent factor for survival in multivariate analysis. Conclusion Surgical resection of recurrent BM may improve the clinical status and thus OS, but is associated with a high complication rate; thus, careful patient selection is crucial.

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