Effect of Postoperative Radiotherapy for Brain Metastases: An Analysis

Abstract

Introduction: Brain metastases (BM) have a very poor prognosis, creating a demand for effective local therapies, such as radiotherapy (RT) and neurosurgery, the combination of which is debatable. The aim of the present study was to investigate prognostic factors and to develop treatment recommendations for patients with BM. Material and Methods: A total of 84 patients treated between May 2011 and July 2016 were analyzed in a single-institution retrospective study. Results: Overall survival (OS) was 10.3 months. Poor OS was defined by a Karnofsky performance index of ≤70% (2.9 vs. 15.8 months; p = 0.009), male gender (6.5 vs. 18.3 months; p = 0.044), and incomplete neurosurgical resection (2.5 vs. 15.8 months; p = 0.017). These factors were also shown to be significant in univariate analysis, while only radical resection remained significant in multivariate testing (p = 0.023). A direct comparison between whole-brain RT (with or without boost) and local RT illustrated a superior OS for local therapy (22.7 vs. 9.5 months; p = 0.022), especially in case of up to 3 metastases (p = 0.041). Intracranial control was 81% with a median duration of 31.6 months. Conclusion: Combined modality treatment of RT and neurosurgery is effective and feasible. A complete removal of all metastases is the cardinal prognostic factor.

External Validation of a Prognostic Score for Patients with Brain Metastases: Extended Diagnosis-Specific Graded Prognostic Assessment

“…The current treatment options for patients with brain metastases include much more efficacious approaches than those available 10 or 20 years ago, including but not limited to high-precision focal radiotherapy and newly approved medications [1][2][3][4][5]. Fortunately, many patients benefit from these treatments, both in terms of symptom control or prevention, radiological disease control, and overall survival.…”

Recursive Partitioning Analysis of Systemic Therapy after Radiotherapy in Patients with Brain Metastases

“…It would be reassuring if one could assess the likelihood of systemic therapy when making treatment recommendations, parallel to looking at the patient's prognostic factors for survival. The latter assessment is often based on well-established prognostic models such as scores and nomograms [2,[24][25][26][27]. One of the aims of careful evaluation is to avoid unnecessarily complicated treatment in the final stage of disease [28][29][30].…”

Radiation therapy for patients with brain metastases from non-small cell lung cancer without driven gene mutation

“…Aside from the aforementioned systematic treatment, surgery is usually recommended for symptomatic and limited BM, and radical resection of brain lesions confers a high LCR. Oertel et al [ 22 ] indicated that local radiotherapy after surgery is more favorable than WBRT or WBRT with SIB.…”