The clinical utility of prognostic scoring systems in patients with brain metastases treated with radiosurgery

Zindler, Jaap; Rodrigues, George; Haasbeek, Cornelis J.A.; Haan, Patricia F. de; Meijer, Otto W.M.; Slotman, Ben J.; Lagerwaard, Frank J.

doi:10.1016/j.radonc.2013.01.015

Cited by 49 publications

(33 citation statements)

References 20 publications

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“…Gerosa et al (23) concluded that the performance status, age, extracranial metastases and primary tumor control caused a potential effect on survival. Zindler et al (24) revealed the prognostic value of performance status, age, absence of extracranial metastases, primary tumor site, gender and steroid response for OS. Rotin et al (25) indicated that the factors influencing survival were the number of brain metastases and KPS.…”

Section: Discussionmentioning

confidence: 99%

Prognostic factors analysis in EGFR mutation-positive non-small cell lung cancer with brain metastases treated with whole brain-radiotherapy and EGFR-tyrosine kinase inhibitors

Wei

Lin

et al. 2016

Oncology Letters

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Abstract. The survival time of non-small cell lung cancer (NSCLC) patients with brain metastases has been previously reported to be 6.5-10.0 months, even with systematic treatment. Patients that possess a certain epidermal growth factor receptor (EGFR) mutation alongside NSCLC with brain metastases also have a short survival rate, and a reliable prognostic model for these patients demonstrates a strong correlation between the outcome and treatment recommendations. The Cox proportional hazards regression and classification tree models were used to explore the prognostic factors in EGFR mutation-positive NSCLC patients with brain metastases following whole-brain radiation therapy (WBRT) and EGFR-tyrosine kinase inhibitor (EGFR-TKI) treatment. A total of 66 EGFR mutation-positive NSCLC patients with brain metastases were retrospectively reviewed. Univariate and multivariate analyses by Cox proportional hazards regression were then performed. The classification tree model was applied in order to identify prognostic groups of the patients. In the survival analysis, age, carcinoembryonic antigen (CEA) and status of the primary tumor were prognostic factors for progression free survival (P=0.006, 0.014 and 0.005, respectively) and overall survival (P= 0.009, 0.013 and 0.009, respectively). The classification tree model was subsequently applied, which revealed 3 patient groups with significantly different survival times: Group I, age <65 years and CEA ≤10 µg/ml; Group II, age <65 years and CEA >10 µg/ml or age ≥65 years and CEA ≤10 µg/ml; and Group III, age ≥65 years and CEA >10 µg/ml. The major prognostic predictors for EGFR mutation-positive NSCLC patients with brain metastases following WBRT and EGFR-TKI were age and CEA. In addition, primary tumor control may be important for predicting survival. IntroductionPatients with non-small cell lung cancer (NSCLC) possess a high risk of developing brain metastases. The incidence rate of brain metastases for patients with lung cancer is 23-65% (1). Once intracerebral metastases develop, the prognosis is poor. The median survival time for patients with untreated brain metastases is only ~1 month (2,3). The principle therapeutic modality for brain metastases is whole-brain radiation therapy (WBRT), and the median survival time following this treatment may increase to 4-6 months. Although therapies, including surgery, WBRT, stereotactic radiotherapy and systematic chemotherapy, are rapidly improving, the prognosis of patients with brain metastases from lung cancer remains poor, and the median survival time for patients remains at ~6.5-10 months (4-7).In 2004, the genes encoding the read code box of epidermal growth factor receptor (EGFR) were sequenced (8). In addition, the gene mutation status has been elucidated and is now widely used in clinical practice. As a result, the identification of the EGFR mutation and the introduction of treatment with EGFR-tyrosine kinase inhibitors (EGFR-TKI) has improved clinical outcomes (9). EGFR-TKI regimens have a good efficacy against brain...

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Section: Discussionmentioning

confidence: 99%

Prognostic factors analysis in EGFR mutation-positive non-small cell lung cancer with brain metastases treated with whole brain-radiotherapy and EGFR-tyrosine kinase inhibitors

Wei

Lin

et al. 2016

Oncology Letters

View full text Add to dashboard Cite

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“…Prognosis is influenced by burden of intra-and extracranial disease, performance status, and symptom severity. Moreover, eligibility for effective local and systemic treatment is pivotal [1][2][3][4]. To facilitate pre-treatment assessment, several prognostic scores have been developed and validated, e.g., the diagnosisspecific graded prognostic assessment (DS-GPA) score for patients with brain metastases from renal cell carcinoma; malignant melanoma; and lung, breast, and gastrointestinal cancers [5,6].…”

Section: Introductionmentioning

confidence: 99%

Tumor marker analyses in patients with brain metastases: patterns of practice and implications for survival prediction research

et al. 2015

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This study aims to explore patterns of practice of tumor marker analyses and potential prognostic impact of abnormal markers in patients with brain metastases from solid tumors. Previously, lactate dehydrogenase (LDH) and albumin were identified as relevant biomarkers. We performed a retrospective analysis of 120 patients with known LDH and albumin treated with whole-brain radiotherapy (WBRT) in two different situations: (1) brain metastases detected at initial cancer diagnosis (n = 46) and (2) brain metastases at later time points (n = 74, median interval 13 months). Twenty-six patients (57 %) from group 1 had at least one tumor marker analyzed, and 11 patients (24 %) had abnormal results. Twenty-two patients (30 %) from group 2 had at least one tumor marker analyzed, and 16 patients (22 %) had abnormal results. When assuming that LDH and albumin would be standard tests before WBRT, additional potential biomarkers were found in 36 % of patients with normal LDH and albumin. Marker positivity rates were for example 80 % for carcinoembryonic antigen (CEA) in colorectal cancer and 79 % for CA 15-3 in breast cancer. Abnormal markers were associated with presence of liver metastases. CA 15-3 values above median predicted shorter survival in patients with breast cancer (median 1.9 vs. 13.8 months, p = 0.1). Comparable trends were not observed for various markers in other tumor types. In conclusion, only a minority of patients had undergone tumor marker analyses. Final group sizes were too small to perform multivariate analyses or draw definitive conclusions. We hypothesize that CA 15-3 could be a promising biomarker that should be studied further.

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“…The prognostic factors related to better survival for patients with brain metastases have been studied in numerous clinical trials; many prognostic classifications [7] have been proposed in the last two decades to define the prognosis and consequently the better therapeutic option. Performance status, age and presence of extracranial metastases were considered in all classifications.…”

Section: Discussionmentioning

confidence: 99%

The treatment of patients with 1–3 brain metastases: is there a place for whole brain radiotherapy alone, yet? A retrospective analysis

et al. 2015

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The clinical utility of prognostic scoring systems in patients with brain metastases treated with radiosurgery

Cited by 49 publications

References 20 publications

Prognostic factors analysis in EGFR mutation-positive non-small cell lung cancer with brain metastases treated with whole brain-radiotherapy and EGFR-tyrosine kinase inhibitors

Prognostic factors analysis in EGFR mutation-positive non-small cell lung cancer with brain metastases treated with whole brain-radiotherapy and EGFR-tyrosine kinase inhibitors

Tumor marker analyses in patients with brain metastases: patterns of practice and implications for survival prediction research

The treatment of patients with 1–3 brain metastases: is there a place for whole brain radiotherapy alone, yet? A retrospective analysis

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