scholarly journals Cavity-directed radiosurgery as adjuvant therapy after resection of a brain metastasis

2011 ◽  
Vol 114 (6) ◽  
pp. 1585-1591 ◽  
Author(s):  
Courtney A. Jensen ◽  
Michael D. Chan ◽  
Thomas P. McCoy ◽  
J. Daniel Bourland ◽  
Allan F. deGuzman ◽  
...  
Keyword(s):  
Overall Survival ◽  
High Resolution ◽  
Brain Metastasis ◽  
Mr Imaging ◽  
Brain Metastases ◽  
Treatment Failure ◽  
Local Treatment ◽  
Resection Cavity ◽  
Kaplan Meier ◽  
Cause Specific Survival

Object As a strategy to delay or avoid whole-brain radiotherapy (WBRT) after resection of a brain metastasis, the authors used high-resolution MR imaging and cavity-directed radiosurgery for the detection and treatment of further metastases. Methods Between April 2001 and October 2009, 112 resection cavities in 106 patients with no prior WBRT were treated using radiosurgery directed to the tumor cavity and for any synchronous brain metastases detected on high-resolution MR imaging at the time of radiosurgical planning. A median dose of 17 Gy to the 50% isodose line was prescribed to the gross tumor volume, defined as the rim of enhancement around the resection cavity. Patients were followed up via serial imaging, and new brain metastases were generally treated using additional radiosurgery, with salvage WBRT typically reserved for local treatment failure at a resection cavity, numerous failures, or failures occurring at short time intervals. Local and distant treatment failures were determined based on imaging results. Kaplan-Meier curves were generated to estimate local and distant treatment failure rates, overall survival, neurological cause–specific survival, and time delay to salvage WBRT. Results Radiosurgery was delivered to the resection cavity alone in 57.5% of patients, whereas 24.5% of patients also received treatment for 1 synchronous metastasis, 11.3% also received treatment for 2 synchronous metastases, and 6.6% also received treatment for 3–10 additional lesions. The median overall survival was 10.9 months. Overall survival at 1 year was 46.8%. The local tumor control rate at 1 year was 80.3%. The disease control rate in distant regions of the brain at 1 year was 35.4%, with a median time of 6.9 months to distant failure. Thirty-nine of 106 patients eventually received salvage WBRT, and the median time to salvage WBRT was 12.6 months. Kaplan-Meier estimates showed that the rate of requisite WBRT at 1 year was 45.9%. Neurological cause–specific survival at 1 year was 50.1%. Leptomeningeal failure occurred in 8 patients. One patient had treatment failure within the resection tract. Seven patients required reoperation: 2 for resection cavity recurrence, 3 for radiation necrosis, 1 for hydrocephalus, and 1 for a CSF cutaneous fistula. On multivariate analysis, a preoperative tumor diameter > 3 cm was predictive of local treatment failure. Conclusions Cavity-directed radiosurgery combined with high-resolution MR imaging detection and radiosurgical treatment of synchronous brain metastases is an effective strategy for delaying and even foregoing WBRT in most patients. This technique provides acceptable local disease control, although distant treatment failure remains significant.

Outcome evaluation of patients treated with fractionated Gamma Knife radiosurgery for large (> 3 cm) brain metastases: a dose-escalation study

2020 ◽  
Vol 133 (3) ◽  
pp. 675-684 ◽  
Author(s):  
Kyung Hwan Kim ◽  
Doo-Sik Kong ◽  
Kyung Rae Cho ◽  
Min Ho Lee ◽  
Jung-Won Choi ◽  
...  
Keyword(s):  
Overall Survival ◽  
Risk Factor ◽  
Brain Metastases ◽  
Treatment Failure ◽  
Gamma Knife ◽  
Dose Escalation ◽  
Radiation Necrosis ◽  
Local Treatment ◽  
Gamma Knife Radiosurgery ◽  
Dose Escalation Study

OBJECTIVEFractionated Gamma Knife radiosurgery (GKS) represents a feasible option for patients with large brain metastases (BM). However, the dose-fractionation scheme balanced between local control and radiation-induced toxicity remains unclear. Therefore, the authors conducted a dose-escalation study using fractionated GKS as the primary treatment for large (> 3 cm) BM.METHODSThe exclusion criteria were more than 3 lesions, evidence of leptomeningeal disease, metastatic melanoma, poor general condition, and previously treated lesions. Patients were randomized to receive 24, 27, or 30 Gy in 3 fractions (8, 9, or 10 Gy per fraction, respectively). The primary endpoint was the development of radiation necrosis assessed by a neuroradiologist blinded to the study. The secondary endpoints included the local progression-free survival (PFS) rate, change in tumor volume, development of distant intracranial progression, and overall survival.RESULTSBetween September 2016 and April 2018, 60 patients were eligible for the study, with 46 patients (15, 17, and 14 patients in the 8-, 9-, and 10-Gy groups, respectively) available for analysis. The median follow-up duration was 9.6 months (range 2.5–25.1 months). The 6-month estimated cumulative incidence of radiation necrosis was 0% in the 8-Gy group, 13% (95% confidence interval [CI] 0%–29%) in the 9-Gy group, and 37% (95% CI 1%–58%) in the 10-Gy group. Being in the 10-Gy group was a significant risk factor for the development of radiation necrosis (p = 0.047; hazard ratio [HR] 7.2, 95% CI 1.1–51.4). The 12-month local PFS rates were 65%, 80%, and 75% in the 8-, 9-, and 10-Gy groups, respectively. Being in the 8-Gy group was a risk factor for local treatment failure (p = 0.037; HR 2.5, 95% CI 1.1–29.6). The mean volume change from baseline was a 47.5% decrease in this cohort. Distant intracranial progression and overall survival did not differ among the 3 groups.CONCLUSIONSIn this dose-escalation study, 27 Gy in 3 fractions appeared to be a relevant regimen of fractionated GKS for large BM because 30 Gy in 3 fractions resulted in unacceptable toxicities and 24 Gy in 3 fractions was associated with local treatment failure.

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 MET-01 INDICATION AND OUTCOME OF SALVAGE SURGERY FOR LOCAL PROGRESSION OF BRAIN METASTASIS PREVIOUSLY TREATED WITH STEREOTACTIC IRRADIATION

2019 ◽  
Vol 1 (Supplement_2) ◽  
pp. ii35-ii35
Author(s):  
Koichi Mitsuya ◽  
Shoichi Deguchi ◽  
Yoko Nakasu ◽  
Nakamasa Hayashi
Keyword(s):  
Overall Survival ◽  
Prognostic Factors ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Salvage Surgery ◽  
Primary Cancer ◽  
Stereotactic Irradiation ◽  
Meaningful Improvement ◽  
Local Progression ◽  
Clinical Records

Abstract PURPOSE To determine treatment outcome following salvage surgery (SS) for local progression of brain metastasis treated by stereotactic irradiation (STI). METHODS The clinical records of patients who underwent SS of local progression of brain metastases after STI at our institute between October 2002 and July 2019 were retrospectively reviewed. Kaplan-Meier curves were used for the assessment of overall survival (OS). The decision to perform SS was based on findings of magnetic resonance imaging and/or clinical evidence of local progression of the brain metastases and status of systemic disease. Prognostic factors for survival were analyzed; age, sex, primary cancer, RPA classification at surgery, extent of resection, radiotherapy after salvage surgery, and pre-surgical neutrophil-to-lymphocyte ratio (NLR). RESULTS Fifty-four SS of 48 patients were performed. The median age of the patients was 63 years (range 36–79). The median interval from STI to SS was 12 months. The median overall survival was 20.2 months from SS. Primary cancer were lung 34, breast 10, and other 10. Fourteen of 54 lesions (26%) developed local recurrence. Leptomeningeal dissemination occurred after the SS in 3 patients (5.7%). RPA classification (1 vs 3, HR:0.16, 95%CI: 0.03–0.59) (2 vs 3, HR:0.44, 95%CI:0.19–0.97) and primary cancer (breast vs lung, HR:0.21, 95%CI:0.05–0.64) (breast vs others, HR:0.08, 95%CI:0.015–0.32) (lung vs others, HR:0.38, 95%CI:0.16–0.94)) were identified as good prognostic factors of overall survival in multivariate analysis. The optimum NLR threshold value was identified as 3.65 for 1-year survival from SS (AUC0.62, sensitivity:71%). CONCLUSIONS Salvage surgery for local progression of brain metastases after STI in selected cases leads to a meaningful improvement in survival.

Brain metastases in patients treated with targeted therapy for metastatic renal cell carcinoma (mRCC).

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 326-326
Author(s):  
H. Alharbi ◽  
T. K. Choueiri ◽  
C. K. Kollmannsberger ◽  
S. North ◽  
M. J. MacKenzie ◽  
...  
Keyword(s):  
Overall Survival ◽  
Targeted Therapy ◽  
Brain Metastases ◽  
Treatment Time ◽  
Karnofsky Performance Status ◽  
Performance Status ◽  
Local Treatment ◽  
Multivariable Analysis ◽  
First Line ◽  
The Brain

326 Background: Patients with brain metastases from advanced RCC treated in the targeted therapy era are not well characterized. Methods: Data from patients with mRCC treated with targeted therapy were collected through the International mRCC Database Consortium from 6 centers. Results: One hundred six out of 705 (15%) patients with mRCC had brain metastases. Forty-seven patients had brain metastases at the start of first-line anti-VEGF therapy and the rest developed metastases during follow-up. Of the patients with brain metastases, 6%, 68%, and 26% were in the favorable, intermediate and poor prognosis groups, respectively, per the Heng et al JCO 2009 criteria. Ninety percent had cerebral metastases, 17% had cerebellar metastases, 40% had a Karnofsky performance status (KPS) <80%, and 81% had symptoms of brain metastases. The median largest size and number of brain metastases was 1.8 cm (range 0.2–6.6) and 1 (range 1–20), respectively. Patients were treated with first-line sunitinib (n=77), sorafenib (n=23), bevacizumab (n=5), and temsirolimus (n=1). Local disease treatment included whole brain radiotherapy (81%), stereotactic radiosurgery (25%), and neurosurgery (25%). The brain metastases of 59 patients were evaluable and based on the local treatment and/or targeted therapy achieved 7 (12%) complete responses, 23 (39%) partial responses, 14 (24%) patients with stable disease, and 15 (25%) patients with progressive disease in the brain metastases. Patients with more than 4 brain metastases vs. those with no more than 4 have an overall survival time from diagnosis of brain metastasis of 3.9 vs. 15.4 months (p=0.0051). Previous nephrectomy, sarcomatoid, and non-clear cell histology are not associated with development of brain metastases. On multivariable analysis, KPS<80% (p=0.0139), diagnosis to treatment with targeted therapy <1 year (p=0.0012), and higher number of brain metastases (p=0.0311) were associated with worse survival from diagnosis of brain metastases. Conclusions: In patients with brain metastases from RCC, KPS at start of therapy, diagnosis to treatment time and number of brain metastases may be prognostic factors for overall survival. [Table: see text]

Outcomes from 735 patients with breast cancer brain metastases (BM) according to biological subtype, number of BMs, and systemic treatment after local therapy.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 2078-2078 ◽  
Author(s):  
Anna Niwinska ◽  
Katarzyna Pogoda ◽  
Halina Rudnicka ◽  
Agnieszka Irena Jagiello-Gruszfeld ◽  
Sebastian Rybski ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Systemic Treatment ◽  
Brain Lesion ◽  
Local Treatment ◽  
Local Therapy ◽  
Luminal Breast Cancer ◽  
Solitary Brain Metastasis ◽  
Biological Subtype

2078 Background: To assess survival when BM is detected according to the biological subtype of breast cancer, number of BMs and systemic treatment after local therapy. Methods: Subjects were 735 consecutive breast cancer patients with BM treated during 2003-2015. Whole brain radiotherapy was undertaken in 97%, neurosurgery -19% and systemic therapy was performed in 74% cases. The biological subtypes: triple-negative (TNBC), HER2+ER/PR-, HER2+/ER/PR+ and ER/PR+HER2- (Luminal) were determined in 714 subjects. Survival after BM detection was assessed in the entire group, in patients with a single BM (1 brain lesion regardless of metastases in other organs) and those with a solitary brain metastasis (1 brain lesion but no metastases in other organs). Factors influencing survival upon detecting BM were assessed by Cox multivariate analysis. Results: The median survivals for all patients with TNBC, HER2+ER/PR-, HER2+/ER/PR+ and Luminal breast cancer BM were respectively 4, 8, 10 and 9 months (p < 0.001). In those both treated and untreated systemically within the TNBC, HER2+ER/PR-, HER2+/ER/PR+ and Luminal subtypes survivals were correspondingly 6, 10, 14, 11 and 2, 3, 2, 2 months (p < 0.001). Median survivals of 171 patients with a single BM treated and untreated systemically were respectively 15 and 5 months (p < 0.001). Median survivals of 70 patients with solitary BM treated and untreated systemically were respectively 28 and 6 months (p < 0.001). In patients with solitary brain metastasis, median survival within the TNBC, HER2+ER/PR-, HER2+/ER/PR+ and Luminal subtypes, with systemic treatment was respectively 16, 28, 28, 28 months and without systemic treatment 6, 7, 7 and 7 months (p < 0.001). Conclusions: Patients with TNBC and BM had the worst prognosis. Systemic treatment performed after local therapy is an important factor prolonging survival of patients with breast cancer BM, even in those with solitary brain metastasis. Based on the present evidence and our recent publication, systemic treatment should be performed in all patients with BM after local treatment, even those with brain metastases as an isolated recurrence.

scholarly journals Outcomes Associated with Therapeutic Anticoagulation in Patients with Brain Metastasis

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 1242-1242
Author(s):  
Shafia Rahman ◽  
Fahrettin Covut ◽  
Yihong Zhou ◽  
Shab E Gul Rahim ◽  
Sudha Amarnath ◽  
...  
Keyword(s):  
Overall Survival ◽  
Brain Metastasis ◽  
Cumulative Incidence ◽  
Initial Diagnosis ◽  
Leptomeningeal Disease ◽  
Primary Cancer ◽  
Kaplan Meier ◽  
Therapeutic Anticoagulation ◽  
Clinically Significant

Abstract Background:Venous thromboembolism (VTE) is a highly prevalent complication of cancer and its treatment and is commonly treated with anticoagulation1. However, there are limited data regarding the use of therapeutic anticoagulation in patients with brain metastases, due to concerns for intracranial hemorrhage (ICH). Methods:We retrospectively identified cancer patients who were diagnosed with brain metastasis between 12/2005 and 7/2017, and subsequently underwent whole brain radiation at the Cleveland Clinic. Patients with primary brain tumors, leptomeningeal disease alone, and absence of follow-up brain imaging were excluded. Clinically significant ICH was defined as ICH resulting in focal neurologic deficit or required neurosurgery, as previously described2. Cumulative incidence of ICH from initial diagnosis of brain metastasis was calculated with death as competing risk. Difference between cumulative incidence estimates was tested using Gray's test. Overall survival (OS) calculated from initial diagnosis of brain metastasis, estimated by the Kaplan-Meier method, and compared by the log-rank test. Median follow-up time was calculated using reverse Kaplan-Meier method. Predictors identified as statistically significant on univariate logistic regression analysis (p<0.05) were selected for multivariate analysis. Results:We screened568 patients and identified 407 who meet inclusion criteria. Seventy-eight (19%) patients received therapeutic anticoagulation (AC) [enoxaparin: n = 46 (59%), warfarin: n = 27 (35%), apixaban/rivaroxaban: n = 3 (4%), unfractionated heparin: n = 2 (2%)] due to VTE after diagnosis of brain metastasis, whereas 329 (81%) patients did not receive any therapeutic dose of AC. There were more female patients in the AC cohort, but other baseline characteristics were similar in both cohorts (Table 1). In the AC cohort, 11 of 78 (14%) patients had ICH, of which 6 (55%) were clinically insignificant and 5 (45%) were clinically significant at initial diagnosis of brain metastasis. Five of 11 patients were already on AC before diagnosis of brain metastasis. In the no-AC cohort, 65 of 329 (20%) patients had ICH, of which 53 (82%) clinically insignificant and 12 (18%) clinically significant at initial diagnosis of brain metastasis. Median follow-up of patients was 28 months. The 3-year cumulative incidence of clinically insignificant ICH in AC and no-AC groups was 7.7 (95% CI: 1.8 - 13.6) and 21.3 (95% CI: 16.5 - 26.1), respectively (p = 0.017). The 3-year cumulative incidence of clinically significant ICH in AC and no-AC groups was 12.0 (95% CI: 4.6 - 19.4) and 4.9 (95% CI: 2.6 - 7.4), respectively (p = 0.044). The 3-year cumulative incidence of all ICH in AC and no-AC groups was 19.7 (95% CI: 10.7 - 28.7) and 25.8 (95% CI: 20.9 - 30.7), respectively (p = 0.27). The 3-year OS in AC and no-AC groups was 13.6 (95% CI: 6.9 - 26.4) and 17.6 (95% CI: 12.9 - 23.9), respectively (p = 0.64) (Figure 1). In univariable analysis, AC vs no-AC [OR: 2.39, 95% CI: 1.00 - 5.48, p = 0.044] and primary cancer (melanoma vs lung) [OR: 5.62, 95% CI: 1.78 - 16.49, p = 0.002] were predictors of clinically significant ICH after diagnosis of brain metastasis (Table 2). In multivariable analysis, only primary cancer (melanoma vs lung) [OR: 6.19, 95% CI: 1.92 - 18.88, p = 0.001]remained a statistically significant predictor of clinically significant ICH after diagnosis of brain metastasis. Conclusion: In this relatively large cohort of patients with brain metastasis, use of therapeutic anticoagulation did not influence the incidence of developing ICH but was associated with a greater risk of clinically significant ICH. This increase was, however, not linked to differences in overall survival. Nearly all patients in our AC cohort were treated with enoxaparin; ongoing studies will examine whether anticoagulation with DOACs is associated with similar outcomes. Disclosures Khorana: Bayer: Consultancy; Sanofi: Consultancy; Janssen: Consultancy; Pfizer: Consultancy.

Staged Stereotactic Radiosurgery for Large Brain Metastases: Local Control and Clinical Outcomes of a One-Two Punch Technique

Neurosurgery ◽  
2017 ◽  
Vol 83 (1) ◽  
pp. 114-121 ◽  
Author(s):  
Ammoren Dohm ◽  
Emory R McTyre ◽  
Catherine Okoukoni ◽  
Adrianna Henson ◽  
Christina K Cramer ◽  
...  
Keyword(s):  
Overall Survival ◽  
Brain Metastases ◽  
Stereotactic Radiosurgery ◽  
Radiation Necrosis ◽  
Treatment Options ◽  
Radiation Therapy Oncology Group ◽  
Local Failure ◽  
Median Dose ◽  
Kaplan Meier ◽  
Dosimetric Analysis

Abstract BACKGROUND Treatment options are limited for large, unresectable brain metastases. OBJECTIVE To report a single institution series of staged stereotactic radiosurgery (SRS) that allows for tumor response between treatments in order to optimize the therapeutic ratio. METHODS Patients were treated with staged SRS separated by 1 mo with a median dose at first SRS of 15 Gy (range 10-21 Gy) and a median dose at second SRS of 14 Gy (range 10-18 Gy). Overall survival was evaluated using the Kaplan-Meier method. Cumulative incidences were estimated for neurological death, radiation necrosis, local failure (marginal or central), and distant brain failure. Absolute cumulative dose–volume histogram was created for each treated lesion. Logistic regression and competing risks regression were performed for each discrete dose received by a certain volume. RESULTS Thirty-three patients with 39 lesions were treated with staged radiosurgery. Overall survival at 6 and 12 mo was 65.0% and 60.0%, respectively. Cumulative incidence of local failure at 6 and 12 mo was 3.2% and 13.3%, respectively. Of the patients who received staged therapy, 4 of 33 experienced local failure. Radiation necrosis was seen in 4 of 39 lesions. Two of 33 patients experienced a Radiation Therapy Oncology Group toxicity grade &gt; 2 (2 patients had grade 4 toxicities). Dosimetric analysis revealed that dose (Gy) received by volume of brain (ie, VDose(Gy)) was associated with radiation necrosis, including the range V44.5Gy to V87.8Gy. CONCLUSION Staged radiosurgery is a safe and effective option for large, unresectable brain metastases. Prospective studies are required to validate the findings in this study.

Prognostic factors and treatment comparison in small cell neuroendocrine carcinoma of the uterine cervix in the surveillance, epidemiology, and end results database.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e18015-e18015
Author(s):  
Jinluan Li ◽  
Limei Lin ◽  
Zongkai Zhang ◽  
Yunxia Huang ◽  
Qin Lin
Keyword(s):  
Overall Survival ◽  
Neuroendocrine Carcinoma ◽  
Radical Surgery ◽  
Local Treatment ◽  
Treatment Strategies ◽  
Figo Stage ◽  
Small Cell ◽  
Small Cell Neuroendocrine Carcinoma ◽  
Primary Radiotherapy ◽  
Cause Specific Survival

e18015 Background: The purpose of this study was to evaluate the impact of treatment modality to survival outcome in small cell neuroendocrine carcinoma of the uterine cervix (SCNEC) using the Surveillance Epidemiology and End Results (SEER) database. Methods: We identified patients with SCNEC from the SEER program during 1981 to 2014and analyzed significant factors for cause-specific survival (CSS) and overall (OS) using Kaplan–Meier survival and Cox regression proportional hazard methods. Results: A total of 503 SCNEC patients were identified. The median follow- up time was 31 months. The 5-year cause specific survival and overall survival were 36.6% and 30.6%, respectively. The FIGO stages I to IV distributions were 189(37.6%), 108 (21.4%),95 (18.9%), and 111 patients (22.1%), respectively. Of the patients with known local treatment strategies, 177 patients (45.9%) were treated with radical surgery and 209 (54.1%) patients underwent primary radiotherapy. In multivariate analysis, local treatment strategies were independent prognostic factors for CSS and OS. The 5- year CSS according to radical surgery and primary radiotherapy were 50.0% and 27.9%, respectively (P < 0.001). The 5-year OS in patients received radical surgery and primary radiotherapy were 57.8%, and 29.6%, respectively (P < 0.001). In FIGO stage I SCNEC, patients treated with radical surgery had superior CSS (P = 0.001) and OS (P = 0.003) than those with primary radiotherapy. However, in FIGO stage II and III SCNEC, there are no differences observed in CSS and OS according to different local treatment strategies. The results also observed that the addition of brachytherapy impact OS (P = 0.002) in FIGO stage III SENCE. The 5-year cause specific survival and overall survival of patients with FIGO IV were only 11.7% and 7.1%, respectively. Conclusions: Small cell neuroendocrine carcinoma of the cervix is a rare disease with aggressive clinical behavior. The results suggested that radical surgery is the optimal local treatment for early-stage SCNEC and combining radiation therapy with brachytherapy should be suitable for patients with advanced stage.

Survival outcomes of breast cancer patients with brain metastases: Single center experience from Northern India.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e13003-e13003
Author(s):  
Hari Krishna Raju Sagiraju ◽  
Ajay Gogia ◽  
Dayanand Sharma ◽  
S. V. S. Deo ◽  
Sandeep Mathur
Keyword(s):  
Breast Cancer ◽  
Overall Survival ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Metastatic Disease ◽  
Cancer Diagnosis ◽  
Survival Outcomes ◽  
Her2 Positive ◽  
Pathological Characteristics ◽  
Time Of Presentation

e13003 Background: Brain metastasis (BM) is a poor prognostic factor for survival among breast cancer (BC) patients. Very few studies reported in the literature have challenged this premise, suggesting that time to the occurrence of brain metastasis and the survival times following brain metastasis differ significantly between BC subtypes. The purpose of this study was to evaluate the clinico-pathological characteristics associated with brain metastasis free survival (BMFS), survival after brain metastases (SABM) and overall survival among Indian women with BC and BM. Methods: Among 621 patients treated for metastatic BC from 2015 to 2018 at All India Institute of Medical Sciences-New Delhi, 79 (12.7%) patients were identified to have BM. Of these ten individuals have presented with BM at the time of presentation. Survival analysis and Cox proportional hazards models were fitted to explore clinco-pathological factors that are associated with survival outcomes in these individuals. Results: Median age of the sample is 42 years (range:22-64). Triple negative breast cancers (TNBC) accounted for 25.3% and HER2 positive were 49.4% in our sample. Median time for the occurrence of BM from cancer diagnosis was 20.5 months (95% CI:14.7-26.2) in the overall sample, while among TNBC and HER2 positive tumors was 14.1 and 20.6 months respectively. In Cox multivariable model, T4stage [Hazard Ratio (HR) (95%CI): 2.4(1.1-5.3)], having a metastatic disease other than to brain at the time of presentation [HR(95%CI): 2.8(1.5-5.4)] and TNBC [HR(95%CI): 2.7(1.1-6.7)], was observed to be significantly associated with BMFS. Median SABM was 7.9 months (95% CI 5.2–16.2) and the median overall survival from the cancer diagnosis was 32.4 months (95% CI 23.4–40.8). Adjusted for age, only the presence of multiple brain lesions (>2) was significantly associated with SABM [HR (95%CI): 2.4(1.1-5.2)]. However, TNBC [HR (95%CI): 2.9(1.2-7.4)]and baseline metastatic disease [HR (95%CI): 2.2(1.2-4.2)] were significantly associated with overall survival following cancer diagnosis in these individuals. HER2 positivity was not associated with BMFS or SABM in this cohort. Conclusions: In this single-institutional study, clinical T4 stage, TNBC subtype and baseline metastatic disease have shown to be significantly associated with BMFS and overall survival. These results suggest that women in Indian population with these baseline clinico-pathological characteristics at the diagnosis of breast of cancer should be frequently monitored for BM.

Outcomes and prognostic factors in metastatic renal cell carcinoma patients with brain metastases.

2021 ◽  
Vol 39 (6_suppl) ◽  
pp. 289-289
Author(s):  
İzzet Dogan ◽  
Ayca Iribas ◽  
Nail Paksoy ◽  
Meltem Ekenel ◽  
Sezai Vatansever ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Overall Survival ◽  
Prognostic Factors ◽  
Brain Metastasis ◽  
Brain Metastases ◽  
Cell Carcinoma ◽  
Renal Cell ◽  
De Novo ◽  
Brain Radiotherapy ◽  
Metastatic Sites

289 Background: The study aimed to evaluate the outcomes and prognostic factors in patients with brain metastatic renal cell carcinoma (bmRCC). Methods: The data of 322 patients with renal cell carcinoma, between 2012 and 2020, were retrospectively reviewed. The clinicopathological features and treatments of the patients with bmRCC were recorded. Overall survival (OS) and prognostic factors were evaluated with Kaplan-Meier analysis and Cox-regression analysis. Results: Forty (12.4%) of the patients had bmRCC. The median follow-up period was 7.3 months (range, 0.2-55.5). The male/female ratio was 2.3, and the median age at diagnosis was 62 years (range, 25-84). Seventeen (42.5%) of the patients were de-novo metastatic, and nine (22.5%) of the patients had brain metastases at presentation. The most common extracranial metastatic sites of the disease were lung (72.5%), bone (47.5%), lymph node (27.5%), and liver (12.5%). Twenty-four (60%) patients previously had received various therapies (tyrosine kinase inhibitor, checkpoint inhibitors, or palliative radiotherapy). After brain metastases developed, 92% of the patients received brain radiotherapy (whole-brain radiotherapy or stereotactic radiosurgery), and twenty-five (62.5%) patients received different therapies. Nine patient received sunitinib, nine patient pazopanib, five patient nivolumab, and two patient axitinib. A total of 32 (80%) patients died during the study period. The median OS was 8.8 months (range, 2.9-14.6) for all patients with bmRCC. Six months- and one-years overall survival ratios were 60% and 40%, respectively. In univariate analysis, the number of brain metastasis (p = 0.352), the localization of brain metastasis (p = 0.790), the longest size of brain metastasis (p = 0.454), the number of extracranial metastatic sites (p = 0.812), de-novo metastatic disease (p = 0.177), primary tumor localization (left or right) (p = 0.903), and tumor grade (p = 0.093) were not statistically significant factors on OS. However, age (p = 0.02), a history of nephrectomy (p < 0.001), receiving brain radiotherapy (p = 0.005), and type of treatment (p = 0.044) was statistically significant. Only, the effect of brain radiotherapy on OS (p = 0.011) was confirmed in multivariate analysis. Conclusions: The prognostic data of patients with bmRCC is limited. In this study, we observed that the prognosis of patients with bmRCC was poor. Despite a small number of patients, we detected that the effect of tyrosine kinase inhibitors and nivolumab was comparable, and receiving brain radiotherapy was a prognostic factor for OS.

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