Survival and prognostic factors in patients treated with stereotactic radiotherapy for brain metastases

Leth, Thomas; Öettingen, Gorm von; Lassen‐Ramshad, Yasmin; Lukacova, Slávka; Høyer, Morten

doi:10.3109/0284186x.2014.921724

Cited by 12 publications

(12 citation statements)

References 24 publications

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“…Unfortunately, the electronic medical record documentation does not adequately provide a rationale for the treatment plan chosen. Factors frequently identified with improved survival, such as age, GPA, and systemic cancer status also did not differ between groups [29-30]. Tumor volume and number of tumors treated were also identified as important prognostic factors [29] which were not significantly different as well.…”

Section: Discussionmentioning

confidence: 99%

“…Factors frequently identified with improved survival, such as age, GPA, and systemic cancer status also did not differ between groups [29-30]. Tumor volume and number of tumors treated were also identified as important prognostic factors [29] which were not significantly different as well. Thus, we cannot determine any patient selection bias for SRS in this retrospective study.…”

Section: Discussionmentioning

confidence: 99%

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Radiosurgery to the Postoperative Tumor Bed for Metastatic Carcinoma Versus Whole Brain Radiation After Surgery

Scheitler

Petroski

et al. 2016

Cureus

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BackgroundThe treatment paradigm from postoperative whole brain radiation therapy (WBRT) to post-operative stereotactic radiosurgery (SRS) to the tumor bed has shifted with little data to evaluate whether each treatment modality confers equivalent tumor control and survival outcomes.MethodsPatients with surgical resection of single brain metastases from January 2010 to December 2014 were treated postoperatively with either WBRT or SRS. Retrospective patient data was compared for local control, distant brain recurrence, overall survival, and radiation complications.ResultsForty-six received WBRT, and 37 received tumor bed SRS. Twelve of 35 (34%) SRS patients experienced local recurrence compared to 17 of 31 (55%) WBRT patients (p = 0.09). The median survival was 440 days (14.7 months) for SRS and 202 days (6.7 months) for WBRT (p = 0.062, log-rank). SRS demonstrated improved survival benefit in the first six months (p = 0.0034; Wilcoxon). Radiation-related adverse changes after SRS (22%) were not statistically different from WBRT (8.7%) (p = 0.152). Age (p = 0.08), systemic cancer status (p = 0.30), Graded Prognostic Assessment (p = 0.28), number of brain metastases at diagnosis (p = 0.65), tumor volume at diagnosis (p = 0.13), new brain lesions (p = 0.74) and neurologic versus systemic cause of death (p = 0.11) did not differ between the groups.ConclusionsFollowing surgical resection, tumor bed SRS can be used effectively in lieu of WBRT to treat brain metastases with comparable local control and distant control and without significantly more adverse events.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Radiosurgery to the Postoperative Tumor Bed for Metastatic Carcinoma Versus Whole Brain Radiation After Surgery

Scheitler

Petroski

et al. 2016

Cureus

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“…In this regard, Anshushaug et al (19) also observed that ECOG PS 3/4 was strongly associated with palliative radiotherapy during the last month of life. The impact of performance status as a prognostic factor in patients with brain metastases is well known (20). In a Canadian study, palliative patients with cancer presenting ECOG PS 4 or 3 exhibited a median survival time of 25.5 or 55.0 days, respectively (21).…”

Section: Discussionmentioning

confidence: 99%

Palliative radiotherapy during the last month of life: Predictability for referring physicians and radiation oncologists

et al. 2015

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Abstract.Oncologists commonly overestimate the survival time of patients receiving palliative therapy, which may result in the administration of treatments that are too aggressive for patients near the end of their lives. Previous studies have discussed the negative implications of palliative radiotherapy if administered during the last month of life. Models predicting a limited survival time may improve the ability of the oncologists to tailor the treatment according to the needs of each individual patient. In the present study, prognostic factors for survival time, and the use of palliative radiotherapy during the last month of life, were analyzed in 873 patients. Models predicting the likelihood of administering such therapy were examined, and the risk of receiving radiotherapy during the last month of life was observed to be lower in patients with non-metastatic cancer than in those with metastatic cancer (7 vs. 13%, respectively; P=0.12). On multivariate analysis, 11 factors that significantly influenced the survival time were identified. These findings emphasize the complexity of potential prediction models. The most important risk factor regarding the prediction of extremely short survival times was observed to be an Eastern Cooperative Oncology Group performance status (ECOG PS) of 4, followed by an ECOG PS of 3 (median survival times, 14 and 64 days, respectively). A limited number of patients who received palliative radiotherapy during their last month of life died unexpectedly. Disease-specific prediction models were developed; however, the small number of events available for analysis limited their immediate clinical impact. Furthermore, these prediction models identified a minority of patients who received radiotherapy during the last month of life. In conclusion, the majority of the palliative radiotherapy courses administered to patients with advanced cancer during their last month of life may be preventable if accurate decision models for the clinic are developed. However, due to the complexity associated with the prediction of survival times in patients receiving palliative radiotherapy, large databases are required to allow accurate models to be established. The present study also discusses the recommendations of the Department of Oncology and Palliative Medicine of Nordland Hospital (Bodø, Nordland, Norway) with regard to the use of palliative radiotherapy during the last month of life of patients with terminal cancer.

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“…Several clinical studies have demonstrated the benefit of SRT on local control in brain metastases, either with or without prior resection or whole brain radiation therapy. [5][6][7][8][9][10][11] To minimize side effects and maximize the dose to the tumor, small margins between the clinical target volume and the actual treated volume are chosen, requiring highly accurate treatment delivery. 12,13 However, several uncertainties need to be considered for such treatments: computed tomography (CT) to magnetic resonance imaging registration uncertainties 14 ; contouring, patient setup and treatment delivery uncertainties; and intrafractional patient motion.…”

Section: Introductionmentioning

confidence: 99%

Implementation and validation of a new fixation system for stereotactic radiation therapy: An analysis of patient immobilization

Lang

Linsenmeier

Brown

et al. 2015

Practical Radiation Oncology

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Survival and prognostic factors in patients treated with stereotactic radiotherapy for brain metastases

Cited by 12 publications

References 24 publications

Radiosurgery to the Postoperative Tumor Bed for Metastatic Carcinoma Versus Whole Brain Radiation After Surgery

Radiosurgery to the Postoperative Tumor Bed for Metastatic Carcinoma Versus Whole Brain Radiation After Surgery

Palliative radiotherapy during the last month of life: Predictability for referring physicians and radiation oncologists

Implementation and validation of a new fixation system for stereotactic radiation therapy: An analysis of patient immobilization

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