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.

scholarly journals Postoperative Survival in Patients With Multiple Brain Metastases

Medicina ◽  
2012 ◽  
Vol 48 (6) ◽  
pp. 41 ◽  
Author(s):  
Kaspars Auslands ◽  
Daina Apškalne ◽  
Kārlis Bicāns ◽  
Rolfs Ozols ◽  
Henrijs Ozoli
Keyword(s):  
Brain Metastases ◽  
Radiation Therapy Oncology Group ◽  
Whole Brain Radiotherapy ◽  
Postoperative Survival ◽  
Clinical Factors ◽  
Factors Affecting ◽  
Multiple Brain Metastases ◽  
Brain Radiotherapy ◽  
Number Of Patients ◽  
Radiotherapy Alone

Background and Objective. Although surgery is traditionally performed for patients with a single brain metastasis, an increasing number of patients with multiple brain metastases may also be treated surgically. The objective of the study was to analyze postoperative survival results and the clinical factors affecting these results. Material and Methods. The records of the patients who underwent surgical resection of 2 or more lesions between January 2005 and January 2010 were retrospectively reviewed. Survival was calculated from the date of surgery to the last follow-up evaluation or death, and different clinical factors were analyzed in regard to patient survival. Results. In total, 36 patients underwent one or more craniotomies. The survival of the total group ranged from 16 days to 37.5 months (mean, 29 months). There were 4 deaths within 30 days. When divided into Radiation Therapy Oncology Group RPA classes, the survival time was 11.75, 8.58, and 5.31 months for classes 1, 2, and 3, respectively. Regarding an impact on the survival, a significant association with a favorable outcome was found for the following factors: the number of brain metastases (2–3 vs. 4–6, P=0.046), RPA classes (1 vs. 2 or 3, P=0.0192), and extent of metastasis resection (all vs. partial, P=0.018). Conclusions. Well-selected patients with multiple brain metastases appear to benefit from surgery compared with historical controls of patients treated with whole-brain radiotherapy alone.

The treatment of patients with 1–3 brain metastases: is there a place for whole brain radiotherapy alone, yet? A retrospective analysis

2015 ◽  
Vol 120 (12) ◽  
pp. 1146-1152 ◽  
Author(s):  
Michela Buglione ◽  
Sara Pedretti ◽  
Stefano Gipponi ◽  
Luciano Buttolo ◽  
Paolo Panciani ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Retrospective Analysis ◽  
Whole Brain Radiotherapy ◽  
Whole Brain ◽  
Brain Radiotherapy ◽  
Radiotherapy Alone

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 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 Hypofractionated stereotactic radiotherapy with or without whole-brain radiotherapy for patients with newly diagnosed brain metastases from non–small cell lung cancer

2012 ◽  
Vol 117 (Special_Suppl) ◽  
pp. 49-56 ◽  
Author(s):  
Liang-Hua Ma ◽  
Guang Li ◽  
Hong-Wei Zhang ◽  
Zhi-Yu Wang ◽  
Jun Dang ◽  
...  
Keyword(s):  
Brain Metastases ◽  
Stereotactic Radiotherapy ◽  
Whole Brain Radiotherapy ◽  
Tumor Control ◽  
Newly Diagnosed ◽  
Small Cell Lung ◽  
Hypofractionated Stereotactic Radiotherapy ◽  
Brain Radiotherapy ◽  
Kaplan Meier ◽  
Multiple Metastases

Object This study was undertaken to analyze outcomes in patients with newly diagnosed brain metastases from non–small cell lung cancer (NSCLC) who were treated with hypofractionated stereotactic radiotherapy (HSRT) with or without whole-brain radiotherapy (WBRT). Methods One hundred seventy-one patients comprised the study population. Fifty-four patients received HSRT alone, and 117 patients received both HSRT and WBRT. The median survival time (MST) was determined using the Kaplan-Meier method. Recursive Partitioning Analysis (RPA) and Graded Prognostic Assessment (GPA) were also used to evaluate the results. Univariate and multivariate analyses were performed to determine significant prognostic factors for overall survival. Tumor control, radiation toxicity, and cause of death in the HSRT and HSRT+WBRT groups were evaluated. Results The MST for all patients was 13 months. According to the Kaplan-Meier method, the probability of survival at 1, 2, and 3 years was 51.2%, 21.7%, and 10.1%. The MSTs for RPA Classes I, II, and III were 19, 12, and 5 months, respectively; and the MSTs for GPA Scores 4, 3, 2, and 1 were 24, 14, 12, and 6 months, respectively. The MSTs in the HSRT+WBRT and HSRT groups were 13 and 9 months (p = 0.044), respectively, for all patients, 13 and 8 months (p = 0.031), respectively, for patients with multiple brain metastases, and 16 and 15 months (p = 0.261), respectively, for patients with a single brain metastasis. The multivariate analysis showed that HSRT+WBRT was a significant factor only for patients with multiple brain metastases (p = 0.010). The Kaplan-Meier–estimated tumor control rates at 3, 6, 9, and 12 months were 92.2%, 82.7%, 79.5%, and 68.3% in the HSRT+WBRT group and 73.5%, 58.4%, 51.0%, and 43.3% in the HSRT group, respectively, in all 165 patients (p = 0.001). The estimated tumor control rates at 3, 6, 9, and 12 months were 94.3%, 81.9%, 79.6%, and 76.7%, respectively, in the HSRT+WBRT group and 77.8%, 61.4%, 52.6%, and 48.2%, respectively, in the HSRT group in the 80 patients harboring a single metastasis (p = 0.009). The estimated tumor control rates at 3, 6, 9, and 12 months were 90.5%, 83.5%, 79.5%, and 60.9%, respectively, in the HSRT+WBRT group and 68.2%, 54.5%, 48.5%, and 36.4%, respectively, in the HSRT group in the 85 patients with multiple metastases (p = 0.010). The toxicity incidences of Grade 3 or worse were 6.0% (7 of 117 patients) in the HSRT+WBRT group and 1.9% (1 of 54 patients) in the HSRT group (p = 0.438). The differences in neurological death rates between the HSRT+WBRT group and the HSRT group were not statistically significant (34.4% vs 44.7%, p = 0.125, in all patients; 30.0% vs 52.0%, p = 0.114, in patients with a single metastasis; and 38.0% vs 36.4%, p = 0.397, in patients with multiple metastases). Conclusions The overall survival results in the present study were similar to those in other studies. Hypofractionated stereotactic radiotherapy provides an alternative method to traditional stereotactic radiosurgery. We suggest that WBRT should be combined with HSRT in patients with single or multiple newly diagnosed brain metastases from NSCLC.

scholarly journals Clinicopathologic and Treatment Features of Long-Term Surviving Brain Metastasis Patients

2021 ◽  
Vol 28 (1) ◽  
pp. 549-559
Author(s):  
Archya Dasgupta ◽  
Jayson Co ◽  
Jeff Winter ◽  
Barbara-Ann Millar ◽  
Normand Laperriere ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Disease Free Survival ◽  
Whole Brain Radiotherapy ◽  
Additional Information ◽  
Brain Radiotherapy ◽  
Kaplan Meier ◽  
Radiotherapy Alone ◽  
Extracranial Disease ◽  
Long Term Survivors

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.

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