Clinical factors associated with mortality within three months after radiosurgery of asymptomatic brain metastases from non-small cell lung cancer

Abstract

Purpose Routine brain MRI surveillance frequently diagnoses small, asymptomatic brain metastases from non-small cell lung cancer (NSCLC) that are effectively treated with stereotactic radiosurgery (SRS). A subset of patients, however, may die prior to the onset of symptoms. This study identifies clinical features that distinguish neurologically-asymptomatic NSCLC brain metastases patients that die prior to routine 3 month follow-up after SRS. Methods Retrospective chart review from 2007 to 2017 identified 18 patients with neurologically-asymptomatic NSCLC brain metastases who died < 3 months after SRS. Twenty-eight additional patients meeting criteria and surviving > 6 months after SRS were identified. Clinical factors were examined to determine characteristics correlated with survival using cox proportional hazards and nominal logistic regression models. Logistic regression models using salient factors were trained with 10-fold cross-validation and compared to the graded prognostic assessment (GPA) and score index of radiosurgery (SIR) using the AUC from receiver operant characteristic curves. Results The median survival following SRS was 1.4 and 9.2 months for the < 3 months and > 6 months groups, respectively. Age, number of brain metastases, and Karnofsky performance status were associated with overall survival while gender and interval between primary cancer and first brain metastasis diagnoses were associated with < 3 months and > 6 months survival, respectively. Models using GPA and SIR performed poorly compared to preliminary metrics generated in this study for prognosis of both < 3 months and > 6 months survival. Conclusion Physicians require data to provide high-value, cost-conscious health care. Clinical metrics can screen patients with asymptomatic NSCLC brain metastases likely to die prior to the standard screening interval and observation could be considered.

New scoring system as predictor of 90-day mortality in appendicular skeletal metastases

“…Old age, rapid-type primary tumor, and KPS were found to be insignificant predictors of 90-day mortality in this study [25][26][27][28][29][30]. These results were different from other studies, which might be caused by our shorter time frame of mortality and different pathologic fractures, specifically targeting appendicular bones, instead of spinal metastases.…”

<p>Stereotactic Radiosurgery of Brain Metastasis in Patients with a Poor Prognosis: Effective or Overtreatment?</p>

“…Overall, SRS was associated with a 22-25% risk of early death. This is similar to a previously published series of surgical patients (23% risk of early death) 15 and slightly higher than a recent retrospective study of SRS (19-23% risk), 16,17 probably due to the inclusion of more high-risk patients in our series. Bennett et al 16 reported an increase in risk of death within three months with additional factors from 5% in the most favorable group to 39% in the unfavorable group.…”

Nicotine promotes brain metastasis by polarizing microglia and suppressing innate immune function

“…The majority of the lung cancer patients are diagnosed with advanced stage disease, most with stage IV cancer. More than 90% of lung cancer deaths are attributed directly to the metastatic disease and include those brain metastases ( Ali et al, 2013 ; Kakusa et al, 2018 ). Cigarette smoking is a major risk factor for lung cancer ( Lee et al, 2012 ), and our previous study showed a negative impact of smoking on lung cancer brain metastasis ( Shenker et al, 2017 ).…”