A cure is possible: a study of 10-year survivors of brain metastases

Abstract

Little is known on the natural history, recurrence patterns, neurocognitive outcomes and prognostic factors associated with survival in long-term survivors (≥10 years) from brain metastasis (BM). In this study, the records of 1953 patients who underwent treatment for BM with a potential for ≥10 years of follow-up were reviewed. Cox regression analysis identified factors predictive for overall survival (OS). The median age at brain metastasis diagnosis was 60 years and the median OS was 6.4 months. The 1-year OS rate was 29.9, 12.1 % at 2 years, 3.0 % at 5 years, and 1.3 % at 10 years. On multivariable analysis, factors associated with worse OS included gender (males, HR 1.2), multiple brain metastases (HR 1.3), no surgery (HR 1.8), and no stereotactic radiosurgery (HR 1.8) (p < 0.0001 each). Fifty-six patients (2.9 %) survived ≥5 years; 23 patients (1.2 %) survived ≥10 years and the median survival for ≥10 year survivors was 18.5 years. Six of the 10-year survivors had an intracranial recurrence, five occurred within 11 years from the first treatment. Presence of a solitary lesion or single lesion at the time of brain metastasis diagnosis was associated with improved survival. Eight of the ≥10 year survivors (34.8 %) had no neurological symptoms at last follow-up; none of the 10-year survivors were documented to have a neurologic death. Our study demonstrates that patients with favorable prognostic features should undergo multimodality treatment. Albeit rare, patients who are alive 10 years after treatment for their brain metastases may be considered cured from their intracranial disease.

A New Hope

“…In most studies, rates of OS among LTS were relatively stable during the three to five years following BM diagnosis. Furthermore, Kotecha et al reported that 41% of patients who survived at least five years were alive at 10 years [17]. In our study, 42 patients were alive and without active disease at their last follow up.…”

“…Intracranial disease burden is an important prognostic factor for BM patients [11][12][13]17]. In our cohort, 65% of LTS had a single metastasis.…”

“…Few published reports have described the characteristics of BM patients who were long-term survivors (LTS) [11][12][13][14][15][16][17]. The purpose of our study was to characterize clinical features among BM patients who were LTS patients treated within our institution.…”

Cognitive Decline Secondary to Therapeutic Brain Radiation—Similarities and Differences to Traumatic Brain Injury

“…While cognitive decline secondary to radiation therapy is a problem that continues to be studied, understanding and solving this problem is difficult for several reasons: (1) wide variations in age, treatment technique, tumor types, and cognitive performance scoring make generalizations difficult, (2) most patients are not cured and thus competing sources of cognitive decline such as tumor progression and further chemotherapy confound most analyses, and (3) radiation oncologists are increasingly utilizing the technique of stereotactic radiosurgery (SRS) over whole brain radiotherapy (WBRT) which minimizes dose to the healthy brain, thus limiting the pool of patients that would be best for studying cognitive decline [33,34,35,36,37,38,39,40,41,42].…”

The risk of cataractogenesis after gamma knife radiosurgery: a nationwide population based case-control study

“…Over the past few decades, gamma knife radiosurgery (GKRS) has been increasingly used for intracranial lesions [1–4]. In Taiwan, the up-to-date official information indicates that there are seven gamma knife units and about 1100 patients undergo GKRS every year.…”