Introduction:PIONEER (NCT01185314) was a prospective, multinational, epidemiological study of epidermal growth factor receptor (EGFR) mutations in patients from Asia with newly diagnosed advanced lung adenocarcinoma.Methods:Eligible patients (aged ≥20 years) had untreated stage IIIB/IV adenocarcinoma. The EGFR mutation status (primary end point: positive, negative, or undetermined) of tumor samples (biopsy, surgical specimen, or cytology) was determined (Scorpion amplification refractory mutation system). EGFR mutation frequency was calculated and compared between demographic and clinical subgroups.Results:Of 1482 patients from seven Asian regions, 43.4% of patients were female, median age was 60 years (range, 17–94), and 52.6% of patients were never-smokers. EGFR mutation status was evaluable in tumors from 1450 patients (97.8%) (746 [51.4%] positive; 704 [48.6%] negative). Country, sex, ethnicity, smoking status, pack-years (all p < 0.001), disease stage (p = 0.009), and histology type (p = 0.016) correlated significantly with EGFR mutation frequency. Mutation frequency was 61.1% in females, 44.0% in males; lower in patients from India (22.2%) compared with other areas (47.2%–64.2%); highest among never-smokers (60.7%); and decreased as pack-year number increased (>0–10 pack-years, 57.9%; >50 pack-years, 31.4%) (similar trend by sex). Ethnic group (p < 0.001) and pack-years (p < 0.001) had statistically significant associations with mutation frequency (multivariate analysis); sex was not significant when adjusted for smoking status.Conclusion:PIONEER is the first prospective study to confirm high EGFR mutation frequency (51.4% overall) in tumors from Asian patients with adenocarcinoma. The observed high mutation frequency in demographic/clinical subgroups compared with white populations suggests that mutation testing should be considered for all patients with stage IIIB/IV adenocarcinoma, even males and regular smokers, among Asian populations.

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This simple survival score appears valid and reproducible. It can be used to estimate the survival time of patients with brain metastasis from breast cancer receiving WBRT alone.

This new score appears valid and reproducible. It can help predict the survival of patients with brain metastasis from NSCLC.

Abstract. Background In adult cancer patients developing cerebral metastases, those with cancer of the urinary bladder account for only 1-2% (1, 2). The survival prognosis of this subgroup is poor when compared to patients with cerebral metastasis from other tumor entities like breast cancer and requires significant improvement (1). Better outcomes of treatment may be achieved with new therapeutic developments, for example minimally-invasive surgical techniques, novel systemic therapies and new radiotherapy approaches including stereotactic radiosurgery for more than three lesions and whole-brain-irradiation (WBI) with hippocampal sparing (3-9). Another approach that has gained importance, when aiming to improve the outcomes of cancer patients, is the personalization of the treatment, i.e. optimally tailoring the treatment to the situation and the needs of an individual patient. Such personalized approaches should consider the patient's remaining lifespan (1, 10, 11). Patients with a longer lifespan should receive a treatment that improves their prognoses in terms of local control and survival but with a low risk of late treatment-related morbidity, since many of these patients live long enough to be at risk of experiencing late toxicity (12). In contrast, patients with a short remaining lifespan would be better candidates for a less intensive, shorter treatment to avoid spending much of their remaining life receiving therapy (13). These considerations apply also to radiotherapy of cerebral metastases, in particular if the patients are assigned to receive WBI. Different dosefractionation schedules of WBI are available for this situation, mainly 20 Gy in 5 fractions over 1 week, 30 Gy in 10 fractions over 2 weeks and 40 Gy in 20 fractions over 4 weeks (1). In order to select the appropriate WBI-schedule for an individual, it would be critical to know his or her expected lifespan. This could be estimated with the use of predictive tools (10, 11). Since in patients with cerebral metastases survival prognoses vary between different tumors types, the availability of a specific predictive tool for each tumor is desirable. This study was particularly focused on patients treated with WBI for cerebral metastases from cancer of the bladder. 633

No abstract

The number of involved extracranial organs is an independent prognostic factor of survival in patients with brain metastasis from NSCLC, irrespective of the pattern of extracranial organ involvement.

BackgroundTwelve years ago, a randomized trial demonstrated that a radiosurgery boost added to whole-brain radiotherapy (WBRT) improved intracerebral control (IC) in patients with one to three cerebral metastases. Overall survival (OS) was improved only in the subgroup of patients with a single metastasis but not in the entire cohort. The present study compared both regimens in a different scenario outside a randomized trial.MethodsA total of 252 patients with one to three cerebral metastases were included. Eighty-four patients receiving WBRT plus a planned stereotactic boost and 168 patients receiving WBRT alone were individually matched 1:2 for nine factors including fractionation of WBRT, age, gender, performance score, primary tumor, number of cerebral metastases, extracerebral metastases, recursive partitioning analysis class, and time between cancer diagnosis and WBRT. Each group of three patients was required to match for all nine factors. Both groups were compared for IC and OS.ResultsIC rates at 6, 12, 18 and 24 months were 88, 71, 45 and 22% after WBRT plus stereotactic boost vs. 75, 48, 38 and 22% after WBRT alone (p = 0.005). OS rates at 6, 12, 18 and 24 months were 76, 53, 32 and 25% after WBRT plus stereotactic boost and 67, 45, 29 and 20% after WBRT alone (p = 0.10). In patients with a single lesion, OS rates were also not significantly different (p = 0.12).ConclusionsSimilar to the previous randomized trial from 2004, this matched-pair study showed that a stereotactic boost in addition to WBRT significantly improved IC but not OS.