Comparative Survival in Patients with Brain Metastases from Non-small-Cell Lung Cancer Treated before and after Implementation of Radiosurgery

Greenspoon, Jeffrey; Ellis, Peter; Pond, Gregory R.; Caetano, Samantha‐Jo; Broomfield, J.A.; Swaminath, Arun

doi:10.3747/co.24.3420

Cited by 16 publications

(14 citation statements)

References 17 publications

(67 reference statements)

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“…Harris et al reported that the general survival of GK radiosurgery did not differ with respect to sex and previous WBRT applications (15). Similar to our study, many studies have shown better survival among women than men (2,13,26). Although the survival of disease (35,42).…”

Section: Discussionsupporting

confidence: 89%

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Analysis of survival of patients with brain metastases according to prognostic indexes and treatment strategies

Saginc

Baltalarli²,

Sagtas³

et al. 2019

Turkish Neurosurgery

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AIM: To retrospectively evaluate the overall survival (OS) of patients with brain metastases (BMs) who had been treated with whole brain radiotherapy (WBRT) and Gamma Knife (GK) according to prognostic factors and prognostic index scores. MATERIAL and METHODS: The study included 91 patients with BMs who had been treated with WBRT and/or GK between 2014 and 2017. The patients with BMs were retrospectively evaluated regarding age, sex, Karnofsky Performance Status (KPS), recursive partitioning analysis (RPA) class, basic score for BM (BS-BM), Graded Prognostic Assessment (DS-GPA) index, primary tumour type, extracranial metastases, primary tumour control, number of BMs, and brain metastasectomy. A univariate analysis of the OS was performed using the Kaplan-Meier method, supplemented by the log-rank test. We also applied a multivariate survival analysis using the Cox regression model. RESULTS: The median OS for all patients with BMs was 6 months. Meanwhile, the median OSs for those with WBRT, GK, and WBRT-GK treatment were 6, 4, and 15 months, respectively (p=0.00). In the multivariate analysis, the female sex (p=0.030), brain metastasectomy (p=0.047), treatment with WBRT-GK (p=0.001), and the controlled primary tumour (p=0.007) significantly correlated with the OS. Furthermore, the BS-BM (p=0.022) was closely related with the OS compared to the RPA and DS-GPA in the multivariate analysis. CONCLUSION: The BS-BM was found to better predict the survival of patients with BMs according to the prognostic index scores in the multivariate analysis. Thus, our data suggest that the BS-BM is the most appropriate prognostic index.

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Section: Discussionsupporting

confidence: 89%

“…Similar to our study, the median OS was the highest among patients with breast cancer compared with that of patients with lung cancer and other cancer types (13,15,26). In another study, no difference was reported between the OSs of patients KPS scores was not statistically significant according to the different treatments (p>0.05).…”

Section: Survival Analysissupporting

confidence: 87%

Analysis of survival of patients with brain metastases according to prognostic indexes and treatment strategies

Saginc

Baltalarli²,

Sagtas³

et al. 2019

Turkish Neurosurgery

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“…While Dr. Souza and Sofia were willing to navigate the side effects when Sofia first enrolls, the risks increase once Sofia's cancer metastasises to her brain, which is a relatively common development for lung cancers (see Ali et al 2013, Greenspoon et al 2017. This case highlights how difficult it is to communicate the uncertainty and risk of clinical trials when also trying to account for cancer progression.…”

Section: The Uncertain Consequences Of Trial Drugsmentioning

confidence: 99%

Uncertainty and certain death: the role of clinical trials in terminal cancer care

Cortez

Halpin

2020

Sociology Health & Illness

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We consider uncertainty in relation to clinical trials for terminal non‐small cell lung cancer, which is an aggressive and difficult to treat form of cancer. Using grounded theory to analyse 85 clinical interactions between doctors, patients and family members, we argue that uncertainty is a major source of tension for terminally ill patients, with individuals confronting a choice between transitioning to palliative care or volunteering for an experimental/trial medication that might postpone death. Regardless of their efficacy, patients must also consider how such experimental treatments might impact their quality‐of‐life. We argue that clinical trials produce uncertainty through (i) discussions about the efficacy of clinical trials; (ii) the physiological consequences of clinical trial medications; and (iii) the impact clinical trials have on patient's prognostic understanding of their terminal cancer. Accordingly, while study participants encounter high prognostic certainty (i.e. they have a fatal cancer), they nonetheless experience considerable uncertainty in relation to their participation in clinical trials.

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“…Mozgové metastázy (MTS) sú hlavnou príčinou morbidity a mortality pa cientov s onkologickým ochorením [3]. Medián celkového prežívania (over all survival -OS) s mozgovými MTS je od 3,4-12,1 mesiaca [3,[5][6][7]. Vo všeobecnosti sa udáva, že postihnutie centrálnej nervovej sústavy (CNS) má už iniciálne 7,4 % chorých, počas ochorenia počet vzrastie na 23-30 % [6].…”

Section: úVodunclassified

Pituitary Metastasis in a Patient with Pulmonary Adenocarcinoma Presenting with a Disturbance of Consciousness

Cahajlová¹,

Kollerova²

2018

Klin Onkol

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Východiska: Mozgové metastázy sú jednou z hlavných príčin morbidity a mortality pa cientov s onkologickým ochorením. U nemalobunkového karcinómu pľúc (non-small cell lung cancer-NSCLC) je riziko rozvoja sekundarizmov v centrálnej nervovej sústave (CNS) 30-50 %. Špeciálny dia gnostický a terapeutický problém je nález podozrivých ložísk v hypofýze. V diferenciálnej dia gnostike sa opierame o klinický priebeh ochorenia (poruchy zraku, diabetes insipidus-DI , slabosť atd.), endokrinologické vyšetrenie a zobrazovacie metódy (CT, ale hlavne MR). Niekedy však definitívne rozlúštenie problému prinesie až histologizácia tumorózneho procesu. Prípad: Pa cient vo veku 65 rokov s novodia gnostikovaným metastatickým adenokarcinómom pľúc bol prijatý na naše oddelenie za účelom zahájenia prvého cyklu chemoterapie v zložení cisplatina a navelbin. V úvode hospitalizácie však u pa cienta dochádza k rozvoju kvalitatívnej poruchy vedomia a dezorientácii. Urgentné CT CNS nachádza tumor hypofýzy, MR popisuje masu supra-a intraselárne, s kontaktom na optickú chiazmu. Endokrinologickým vyšetrením zisťujeme panhypopituitarizmus. Pituitárnu metastázu NSCLC potvrdzuje až histologizácia tumoru transfenoidálnym prístupom. Záver: K malignitám najčastejšie metastazujúcim do hypofýzy patria pľúcny karcinóm a karcinóm prsníka. Incidencia pituitárnych metastáz sa udáva od 0,4 do 28,1 %. Klinicky sú väčšinou nemé, môžu sa však manifestovať endokrinologickými poruchami ako sú DI, hypotyreóza a hypokorticizmus alebo poruchami zraku pri útlaku optickej dráhy. Od stanovenia správnej dia gnózy závisí ďalší management pa cienta. Kľúčové slová hypopituitarizmus-magnetická rezonancia-tumor hypofýzy-rádiochirurgia-cielená liečba Autoři deklarují, že v souvislosti s předmětem studie nemají žádné komerční zájmy. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. Redakční rada potvrzuje, že rukopis práce splnil ICMJE kritéria pro publikace zasílané do bi omedicínských časopisů. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.

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Comparative Survival in Patients with Brain Metastases from Non-small-Cell Lung Cancer Treated before and after Implementation of Radiosurgery

Abstract: Introduction Survival after a diagnosis of brain metastasis in non-small-cell lung cancer (nsclc) is generally poor.

Cited by 16 publications

References 17 publications

Analysis of survival of patients with brain metastases according to prognostic indexes and treatment strategies

Analysis of survival of patients with brain metastases according to prognostic indexes and treatment strategies

Uncertainty and certain death: the role of clinical trials in terminal cancer care

Pituitary Metastasis in a Patient with Pulmonary Adenocarcinoma Presenting with a Disturbance of Consciousness

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