The Choice of Local Treatment Modalities for Patients with Brain Metastases from Digestive Cancers

Abstract

Background Brain metastases (BMs) from digestive cancers are rare; therefore, no optimal treatment modality has been defined. Methods We retrospectively reviewed the clinical data of 68257 patients with digestive cancers. Propensity score matching (PSM) was used to balance patient backgrounds between groups. Survival differences between different treatment modalities were compared. Univariate and multivariate Cox proportional hazards models were performed to identify prognostic factors on overall survival (OS). Results 270 patients with BM entered the study. In the entire group, the median survival time after diagnosis of brain metastases was 10.25 months (95% CI: 8.41–12.09 months); local treatment could significantly prolong OS (respectively, P < 0.01; even after PSM, P < 0.01); combination treatment was more effective than single treatment modality (respectively, P < 0.01; even after PSM, P < 0.01). However, each combination modality was identically effective (P > 0.05). When patients were divided into three groups based on 1, 2-3, or more than 3 metastatic lesion(s), same results were identified between local treatment and without local treatment (1 lesion, P < 0.01; 2-3 lesions, P < 0.01; more than 3 lesions, P < 0.01, respectively) and combination and single treatment (P < 0.01, P=0.02, P=0.03, respectively). However, there was no difference between different combined treatments (P > 0.05). Multivariate analysis revealed that performance status (P < 0.01), presence of extracranial metastasis (P=0.04), number of BM (P < 0.01), and local treatment for BM (P < 0.01) were independent prognostic factors. Conclusions Regardless of the number of brain lesions, local treatment achieved higher overall survival times than no local treatment, and combination therapy could offer survival benefit to patients as compared with single therapy.

Patient survival based on temporal relationships between metastatic pancreatic cancer and brain metastases treated in a single institution: An opportunity for early detection

“…Diverse variables, such as the number and size of brain lesions, status of primary disease, tumor histology, and general condition of the patient at time of BM diagnosis are important factors in disease management [14]. If we understand the patterns and processes that indicate the occurrence of BM, we can pursue earlier detection and treatments that not only target the primary tumor but also metastases to the brain [15]. Future studies are war-ranted to highlight multimodal therapy and survival to suggest a more personalized decision-making process [14].…”

“…Based on patientspecific and treatment-related factors, optimal treatment could be tailored specifically for each patient, signaling better prognosis [14]. If we understand the patterns that indicate the occurrence of brain metastases, we can look for treat-ments that not only target the primary tumor but also metastases to the brain [15].…”