Study flowchart. Created using R software version 3. The study was reviewed and approved by the Institutional Review Board of Gachon University Gil Medical Center approval number: GFIRB , and the requirement to obtain written consent was waived due to the retrospective nature of this study; patients and the public were not involved in the study design, data collection, analysis, or interpretation of data.
All study methods were carried out based on the Declaration of Helsinki. The PSM considered the following factors that are associated with overall survival among BM patients: surgical resection, chemotherapy, and primary tumor location. Surgical resection was defined as craniotomy with tumor removal but did not include brain biopsy, which was identified based on the corresponding treatment codes N, S, S, S, and S Treatment codes for the various chemotherapy regimens are listed in Supplemental Table 2.
Overall survival was evaluated using the Kaplan—Meier method and log-rank test. Prognostic variables were evaluated using a Cox proportional hazards model, which was adjusted for age, sex, CCI, chemotherapy use, surgery use, diagnostic year, and primary tumor location.
The PSM was based on factors that likely influenced overall survival, and the PSM scores were calculated using multiple logistic regression.
The variables included sex, age group, medical aid beneficiary status, medical facility classification, primary tumor location, surgery use, chemotherapy use, diagnostic year, and CCI. The PSM was performed using a caliper width of 0. Subgroup analyses were performed according to primary tumor location, given that the prognosis varies according to tumor type.
All analyses were performed using SAS software version 9. JHJ had full access to all study data and takes responsibility for the integrity of the data and the accuracy of the data analysis. However, we excluded patients who were diagnosed after January insufficient follow-up period , patients who were diagnosed before December incomplete records , and patients with primary brain tumors and hematological malignancies Fig.
Thus, the analyses included 84, patients with a median follow-up duration of 6. Among the 84, patients, 37, patients The median follow-up periods were 4. After the PSM, the median follow-up periods were 6. Significant intergroup differences were observed in age, sex, chemotherapy use, and surgery use Table 1.
Furthermore, RT was an independent predictor of overall survival in the multivariate Cox regression analysis adjusted HR: 0. In this table, we presented HR within subgroups by Cox regressions. The non-RT group had overall survival rates of The median survival difference for RT was 2.
The survival curves for the two groups intersected at 2. Kaplan—Meier survival curves according to radiotherapy RT status. Outcomes are shown as overall survival among all patients. Created using SAS software version 9. To overcome selection bias that could occur by excluding the patients with less than five fractions of RT, the analysis was conducted on all patients who received RT at least once, as shown in Supplemental Table 4.
In the intention-to-treat analysis, our results failed to confirm the favorable outcomes of RT patients for BMs. Most BM patients had primary lung cancer, and overall survival after the diagnosis of BM varied according to the primary tumor location. Among patients with primary lung cancer, the median survival difference for RT was 3. However, RT was not associated with a survival difference for other primary tumors, such as breast, liver, colorectal, and stomach cancer. Supplemental Fig.
Cox regression survival analyses for lung cancer. Cox proportional hazards model adjusted for age, sex, CCI, chemotherapy use, surgery use, diagnostic year, and primary tumor location. Supplemental Table 5 shows that these subgroups had well-balanced baseline characteristics after the PSM.
The median survival intervals were Cox regression survival analyses for SRS only vs. We conducted further analysis of patients who received RT at least once. To this end, we divided and reanalyzed patients with RT more than once, patients with one to four fractions RT, and patients with more than five fractions RT Supplemental Table 4 , 6, 7. This retrospective population-based study revealed that RT was associated with a survival difference among Korean patients with BM, especially among patients with BM from lung cancer.
Interestingly, while RT was associated with a survival difference after 1 year, the difference disappeared after 2. The American Society of Radiation Oncology guidelines recommend managing BM based on the estimated prognosis from the histopathological findings However, the utility of RT has been questioned, as WBRT can lower the quality of life for BM patients who have a poor performance status and older age 7.
Our results indicate that RT did not significantly increase the median overall survival of BM patients, although RT was associated with a survival difference after 1 year, which subsequently reversed after approximately 2.
These findings imply that RT may provide a short-term survival difference of approximately 2. We also observed that RT was associated with a survival difference of 3. Nevertheless, the blood—brain barrier is an obstacle to effective chemotherapies for BM, which suggests that RT will continue to play a role in the management of BM patients.
Additionally, the reserve pattern of the survival curve of the non-RT group after 2. Thus, we performed subgroup analyses for the five most common primary tumor locations in Korea: lung cancer, breast cancer, liver cancer, colorectal cancer, and stomach cancer.
The results revealed that RT was associated with a survival benefit among patients with BM from lung cancer, but not among patients with BM from the other primary tumor locations. Several randomized controlled trials have confirmed that WBRT is an important adjuvant treatment after surgical resection and SRS 20 , 21 , However, those studies only evaluated RT within combination treatments and did not confirm whether RT alone offered a survival benefit.
In addition, there is limited research regarding long-term survival in this setting, which is related to the poor prognosis of BM patients. Several reports have indicated that SRS improves overall survival and local control for BM patients 4 , 23 , 24 , while Aoyama et al.
The major strengths of this study are the large Korean sample of BM patients with long-term follow-up data from the nationally representative NHIS database.
However, the present study also has some limitations. First, the study involved a retrospective analysis of claims data, and overall survival was evaluated based on crude mortality rather than cancer-related mortality. Second, although the coding is reasonably accurate, the possibility of incomplete medical records suggests that the proportion of BM patients might have been underestimated.
Third, the NHIS data do not include systematic information regarding RT-related adverse events, which could not be evaluated in the present study, although these factors can affect the long-term survival of cancer patients.
Moreover, even with PSM corrections, the results were not robust because they were not properly distributed. Finally, the major limitation is the selection bias that can occur by excluding less than five fractions of RT. This raises questions about the reliability of these results as they create more favorable conclusions for the RT. Additionally, even if PSM were performed, there was still potential bias due to the lack of accurate comparative analysis of other prognostic variables, such as molecular markers, comorbidities, and status of cancer progression.
Nevertheless, our study is the first investigation to demonstrate the effects of RT for brain metastases through a population-based cohort study. In conclusion, this nationally representative cohort study revealed that Korean patients who received RT for BM had a lower crude mortality rate for 2. In addition, RT was associated with a median survival difference of 3. Chao, J.
Published online May 2. Keith J. Author information Article notes Copyright and License information Disclaimer. Stelzer: ten. Received Jul 12; Accepted Feb 1. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
This article has been cited by other articles in PMC. Abstract A substantial, but uncertain, number of patients with cancer develop brain metastases. Keywords: Biomarkers, brain metastasis, prognosis model. Risk Factors There is increasing interest in understanding risk factors for developing brain metastases that are specific to primary cancers. Table 1 Significant prognostic factors for seminal indices of survival of patients with brain metastases. Open in a separate window. Subgroup application of indices — Treatment With establishment of multiple prognostic indices for patients with brain metastases, attention has been given to determining their utility among subgroups distinguished by therapy.
Subgroup application of indices — Tumor type With the goal of determining if prognostic indices could be more reliable within specific tumor types, diagnosis-specific studies were undertaken.
Conclusions The incidence rate of brain metastases is difficult to estimate, but its magnitude is likely on the order of 10 4 5 per year in the United States. Validation of recursive partitioning analysis classification in patients with brain metastases from non-small cell lung cancer treated with short-course accelerated radiotherapy. Clin Oncol. Int J Cancer. Prophylactic cranial irradiation for patients with small-cell lung cancer in complete remission.
N Engl J Med. Multivariate analysis of factors predictive of brain metastases in localized non-small cell lung carcinoma. Lung Cancer. A nomogram for individualized estimation of survival among patients with brain metastasis.
Neuro Oncol. Predictive factors for the development of brain metastasis in advanced unresectable metastatic melanoma. Am J Clin Oncol. Brain metastases free survival differs between breast cancer subtypes. Br J Cancer. Radiation therapy for intracranial metastatic neoplasia.
Radiol Clin Biol. Chiou SM. Value of radiation therapy in the management of intracranial metastases. Lymphopenia: A new independent prognostic factor for survival in patients treated with whole brain radiotherapy for brain metastases from breast carcinoma. Radiother Oncol. Incidence of intracranial tumors in the Lothian region of Scotland J Neurol Neurosurg Psychiatr. EGFR mutation status and survival after diagnosis of brain metastases in nonsmall cell lung cancer.
Number of metastases, serum lactate dehydrogenase level, and type of treatment are prognostic factors in patients with brain metastases of malignant melanoma.
Sites of recurrence in resected stage I non-small-cell lung cancer: A guide for future studies. J Clin Oncol. Intracranial recurrence of carcinoma after complete surgical resection of stage I, II, and III non-small-cell lung cancer. Epidemiology of central nervous system neoplasms. A regional survey in central Finland.
Acta Neurol Scand. Epidemiology of metastatic brain tumors. Neurosurg Clin N Am. Am J Surg Pathol. Factors associated with the development of brain metastases. Analysis of patients with early stage nonsmall cell lung cancer. Surgical resection of brain metastases: The prognostic value of the graded prognostic assessment score.
J Neurooncol. Identification of prognostic factors in patients with brain metastases: A review of patients. Lang EF, Slater J. Metastatic brain tumors: Results of surgical and nonsurgical treatment. S Clin N Am. Brain metastases from breast carcinoma: Validation of the radiation therapy oncology group recursive partitioning analysis classification and proposition of a new prognostic score. Outcome predictors of Gamma Knife surgery for melanoma brain metastases.
J Neurosurg. Radiosurgery for treatment of brain metastases: Estimation of patient eligibility using three stratification systems. Incidence of local recurrence and second primary tumors in resected stage I lung cancer. J Thorac Cardiovasc Surg. Epidemiology of central nervous system tumors in Labin area, Croatia, Croat Med J.
Prognostic factors for outcomes after whole-brain irradiation of brain metastases from relatively radioresistant tumors: A retrospective analysis. BMC Cancer. Phase III study of prophylactic cranial irradiation vs. Postoperative treatment and prognosis of patients with resected single brain metastasis: How useful are established prognostic scores? Clin Neurol Neurosurg. Can current prognostic scores reliably guide treatment decisions in patients with brain metastases from malignant melanoma?
J Cancer Res Ther. Prognostic factors in brain metastases: Should patients be selected for aggressive treatment according to recursive partitioning analysis RPA classes? Niwinska A, Murawska M. New breast cancer recursive partitioning analysis prognostic index in patients with newly diagnosed brain metastases.
Improvement in quality of survival following whole-brain irradiation for brain metastasis. A new scoring system to predicting the survival of patients treated with whole-brain radiotherapy for brain metastases. Strahlenther Onkol. Scoring systems to estimate intracerebral control and survival rates of patients irradiated for brain metastases. Prophylactic cranial irradiation in extensive small-cell lung cancer.
Brain metastases admissions in Sweden between and A new prognostic index and comparison to three other indices for patients with brain metastases: An analysis of 1, patients in the RTOG database. Diagnostic-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: A multi-institutional analysis of 4, patients.
Effect of tumor subtype on survival and the graded prognostic assessment for patients with breast cancer and brain metastases. Surgical treatment for brain metastases: Prognostic factors and survival in patients with regard to patient age. J Clin Neurosci. Determinants of survival in patients with brain metastases from cutaneous melanoma. Prognostic index to identify patients who may not benefit from whole brain radiotherapy for multiple brain metastases from lung cancer.
J Med Imaging Radiat Oncol. RPA classification has prognostic significance for surgically resected single brain metastasis. Primary breast cancer phenotypes associated with propensity for central nervous system metastases. Every metastatic brain tumor, and every patient, is different. The specialists at Johns Hopkins take the time to determine which treatment or combination of treatments will be the most effective for you. Your neurosurgeon will discuss the most appropriate treatment approach with you by considering these and other factors:.
Along with benefits, doctors also consider the potential risks and side effects of any treatment. Many patients are worried about the effects of radiation.
Others hesitate about the idea of surgery. Tell your doctor about your concerns — they are important to consider. Prognosis for metastatic brain cancer varies greatly. Keep in mind that each patient is unique, and with newer treatments, many patients live longer. Speaking with your care team about your unique diagnosis can provide an accurate prognosis.
Palliative care is specialized medical care that helps patients facing serious illnesses and their families by adding an extra layer of support. Palliative care teams can help with the symptoms and the stress of living with a serious illness, including controlling pain, providing support for the mental and emotional effects of an illness, and managing other symptoms. Health Home Conditions and Diseases.
What You Need to Know Metastatic brain cancer also called secondary brain tumors is caused by cancer cells spreading metastasizing to the brain from a different part of the body. What happens when cancer spreads to the brain? What are the symptoms of brain metastases?
How are metastatic brain tumors diagnosed? Here are some ways doctors may diagnose a metastatic brain tumor: Physical exam: After gathering information about your symptoms and personal and family health history, the doctor proceeds with a physical exam and vision and reflex tests.
It reveals microscopic differences of tissue structure, including very early infiltration of cancer cells. Biopsy : Collecting a piece of the tumor through surgery may be necessary when the diagnosis is unclear based on the other tests. Metastatic Brain Cancer Treatment It is important to know that metastatic brain tumors are often treatable, and can be well-controlled.
The treatment options for brain metastases may include: Surgery Radiation therapy Chemotherapy Targeted drug treatments Immunotherapy Clinical trials In many cases, surgery or radiation therapy can improve — or entirely get rid of — symptoms.
The primary cancer is treatable and under control. The tumor can be safely removed. Radiation Therapy for Metastatic Brain Tumors Radiation therapy treats metastatic brain tumors by using X-rays and other forms of radiation light energy to destroy cancer cells or prevent a tumor from growing.
Procedures may include any one or a combination of the following: External beam radiation therapy delivers radiation from a machine and through the body to reach metastatic tumors.
0コメント