Optimizing treatment of brain metastases in an era of novel systemic treatments: a single center consecutive series

Abstract

Background The multidisciplinary management of patients with brain metastases consists of surgical resection, radiation treatment and systemic treatment. Tailoring and timing these treatment modalities is challenging. This study presents real-world data from consecutively treated patients and assesses the impact of all treatment strategies and their relation with survival. The aim is to provide new insights to improve multidisciplinary decisions towards individualized treatment strategies in patients with brain metastases. Methods A retrospective consecutive cohort study was performed. Patients with brain metastases were included between June 2018 and May 2020. Brain metastases of small cell lung carcinoma were excluded. Overall survival was analyzed in multivariable models. Results 676 patients were included in the study, 596 (88%) received radiotherapy, 41 (6%) awaited the effect of newly started or switched systemic treatment and 39 (6%) received best supportive care. Overall survival in the stereotactic radiotherapy group was 14 months (IQR 5–32) and 32 months (IQR 11–43) in patients who started or switched systemic treatment and initially did not receive radiotherapy. In patients with brain metastases without options for local or systemic treatment best supportive care was provided, these patients had an overall survival of 0 months (IQR 0–1). Options for systemic treatment, Karnofsky Performance Score ≥ 70 and breast cancer were prognostic for a longer overall survival, while progressive extracranial metastases and whole-brain-radiotherapy were prognostic for shorter overall survival. Conclusions Assessing prognosis in light of systemic treatment options is crucial after the diagnosis of brain metastasis for the consideration of radiotherapy versus best supportive care. Graphical Abstract

Overall Survival after Radiotherapy for Brain Metastases According to ECOG Status—A Prospective Study of 294 NSCLC Patients

“…Overall, in multivariable analysis, we confirmed that ECOG performance status ≥2, multiple BMs (≥5), uncontrolled ECMs, and synchronous diagnosis of BMs and lung tumor are associated with poor survival [15,[23][24][25]. Available treatment options to potentially achieve control of ECMs are likely as crucial for survival as treatment of BMs, as most of these patients do not die from BMs per se.…”

“…Available treatment options to potentially achieve control of ECMs are likely as crucial for survival as treatment of BMs, as most of these patients do not die from BMs per se. Due to improved intracerebral response rates with targeted therapy, van Schie et al have proposed that systemic treatment options should be considered as a prognostic factor for survival [24].…”

The Impact of Extracranial Metastatic Features on Patients with Breast Cancer Brain Metastasis: A Retrospective Analysis of 284 Patients

“…Notably, three co-authors nished the assessment separately and discussed the inconsistent opinions. Plenty of other studies have also suggested the status of extracranial disease, instead of their presence, was an independent prognostic factor for BCBM patients [22,26,27]. Thirdly, the quantity of enrolled patients was relatively small, resulting in the di culty to achieve baseline matching between groups.…”