Patterns of Treatment and Outcome in Patients With 20 or More Brain Metastases

Nieder, Carsten; Yobuta, Rosalba; Mannsåker, Bård

doi:10.21873/invivo.11455

Cited by 4 publications

(4 citation statements)

References 20 publications

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“…WBRT remains an appropriate and optional treatment for patients with diffuse BMs with or without leptomeningeal involvement. Research has shown that patients with diffuse BMs (arbitrarily defined as 20 or more lesions) have a chance to survive long enough after WBRT ( 54 ). The cognitive decline caused by WBRT has been widely recognized, and less than 10% of BMs are within 5 mm of the hippocampus.…”

Section: Resultsmentioning

confidence: 99%

CSCO expert consensus on the diagnosis and treatment of breast cancer brain metastasis

Wang¹,

Chen²,

Yang³

et al. 2022

Transl Breast Cancer Res

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Breast cancer is one of the most common malignancies among women worldwide. According to the International Agency for Research on Cancer, breast cancer affected more Chinese women than any other cancer in 2020. The brain is an increasingly common metastatic sites of breast cancer. Although the risk of developing brain metastases (BMs) is lower in breast cancer than in lung cancer and melanoma, due to its high prevalence, it is the second most common cause of BM among solid tumors, being second only to lung cancer. The incidence of breast cancer brain metastasis (BCBM) differs by molecular subtype. Half of patients with advanced human epidermal growth factor receptor-2 (HER2)-positive and one-third of patients with triple-negative breast cancer (TNBC) develop BM. The clinical manifestations of leptomeningeal metastasis (LM) are often non-specific and may manifest as a variety of signs and symptoms, mainly including brain parenchyma involvement and meningeal irritation syndromes cranial nerve involvement, increased

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Section: Resultsmentioning

confidence: 99%

CSCO expert consensus on the diagnosis and treatment of breast cancer brain metastasis

Wang¹,

Chen²,

Yang³

et al. 2022

Transl Breast Cancer Res

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“…Palliative radiotherapy has evolved into a highly individualized treatment concept, which provides symptom palliation and, in selected patients, improves overall survival (1,6,18,19). However, the management of patients with reduced PS (ECOG 3-4) is among several unsolved problems.…”

Section: Discussionmentioning

confidence: 99%

Symptom Burden in Patients With Reduced Performance Status at the Start of Palliative Radiotherapy

Nieder

Kämpe

2020

In Vivo

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Background/Aim: Previous research has suggested that palliative radiotherapy is a useful measure, unless short survival reduces the time spent without active treatment, and in the case of a low likelihood of experiencing a net benefit in quality of life. Patients with reduced performance status (PS) may be especially at risk of futile treatment, despite having a relatively high symptom burden and thus a potential benefit. Therefore, we analyzed the symptom burden of patients with Eastern Cooperative Oncology Group (ECOG) PS 3-4 in our center. Patients and Methods: A retrospective study was performed of 102 consecutive patients who received palliative radiotherapy for different indications. The Edmonton Symptom Assessment Scale (ESAS) was employed to assess the pre-radiotherapy symptoms. Results: When applying the lowest threshold (ESAS ≥1), up to 97% of patients with PS 3-4 reported symptoms, such as fatigue and dry mouth. When focusing on moderate/severe symptoms (ESAS ≥4), still up to 77% of patients with PS 3-4 reported such a burden. The largest differences between patients with PS 3-4 and those with 0-1 were seen with regard to nausea, fatigue, dry mouth and reduced appetite. The median survival of patients with PS 3-4 was 2 months. Conclusion: Given that many of the symptoms reported by patients with PS 3-4 tend to worsen temporarily after radiotherapy, patients with short survival may not experience a net benefit during the few weeks before death. However, if other symptoms such as dyspnea or pain prevail, short-course radiotherapy may result in worthwhile palliation and should, therefore, be considered on a case-bycase basis and after estimation of the remaining lifespan. 735

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“…For this retrospective analysis, a continuously maintained and updated database was employed, which provides data from consecutively irradiated patients with brain metastases since 2006 (real world cohort, complete and incomplete radiotherapy courses, treatment before June 2022, follow-up through October 2022). The database was originally created to allow for regional quality-of-care analyses, has already been utilized (5,7,8,12) and does not require additional approval by the local Ethics Committee (REK Nord). Patients managed with BSC or neurosurgical intervention rather than WBRT were excluded.…”

Section: Methodsmentioning

confidence: 99%

“…Despite increasing utilization of focal radiotherapy, mainly stereotactic radiosurgery (SRS), not all patients are optimal candidates for such treatment. Factors such as number of brain metastases and presence of meningeal spread may still cause clinicians to prefer WBRT, a treatment which is able to provide worthwhile symptom palliation (5). In case of very limited life expectancy, symptom palliation may be too short-lived and possibly overshadowed by other medical issues to result in a clear net benefit.…”

mentioning

confidence: 99%

Prognostic Factors and Independent Validation of a Risk Stratification Model in Octogenarian Patients Irradiated for Brain Metastases

Nieder

Dalhaug

2023

Anticancer Res

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Background/Aim: This study aimed at validation of a prognostic model, originally developed by Rades et al., in an age-restricted, particularly vulnerable subgroup of patients with brain metastases, because international variations in clinical practice and survival outcomes may impact on the performance of survival prediction tools. Materials and Methods: Retrospectively, data from a single institution were analyzed. The study included 50 patients managed with palliative whole-brain radiotherapy. The Rades et al. score was assigned and the resulting 3 prognostic strata compared. Results: The 3-month survival rates for the 3 strata were 0, 35 and 41%, respectively (p<0.001 pooled over all strata, log-rank test for Kaplan-Meier curves). However, the prognostic impact of extracranial metastases suggested by Rades et al., together with performance status and number of brain metastases in their study of 94 patients, was absent. In contrast, cancer type (better survival for breast and melanoma) and lack of steroid treatment were significant in the present study. Conclusion: The original Rades et al. score is a useful prognostic model in our validation database. However, additional factors appear to play a role and might therefore be considered when performing future large-scale studies.

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Patterns of Treatment and Outcome in Patients With 20 or More Brain Metastases

Cited by 4 publications

References 20 publications

CSCO expert consensus on the diagnosis and treatment of breast cancer brain metastasis

CSCO expert consensus on the diagnosis and treatment of breast cancer brain metastasis

Symptom Burden in Patients With Reduced Performance Status at the Start of Palliative Radiotherapy

Prognostic Factors and Independent Validation of a Risk Stratification Model in Octogenarian Patients Irradiated for Brain Metastases

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