Short-term survivors with brain metastases have modest benefits from focal and systemic therapies and remain frequent despite improving treatment landscape

IF 2.7 3区 医学 Q3 ONCOLOGY
M. Czogalla , J. Stöhr , N. Gleim , K. Papsdorf , S. Klagges , P. Hambsch , T. Kuhnt , F. Nägler , A. Barrantes-Freer , J. Wach , N.H. Nicolay , C. Seidel
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引用次数: 0

Abstract

Purpose

Therapeutic options for patients with brain metastases (BM) increase. While these lead to considerable survival effects in subgroups, there is limited knowledge about characteristics, prognosticators and treatment effects in patients with BM and short survival.

Methods

Patients with a survival time of ≤ 6 months (short-term survivors, STS), diagnosed with BM between 2009–2021 at a large tertiary cancer center were analysed. Clinical and treatment characteristics, pathological data and causes of death were documented. Descriptive statistics, treatment-specific univariate Kaplan-Meier estimator analyses and multivariate Cox regression were performed.

Results

Among 1248 patients with BM, 480 (38 %) were STS. 256 STS with detailed clinical records were included in this analysis. In univariate and multivariate analysis, Karnofsky Performance Status (KPS) (p < 0.001) and number of BM (p = 0.004) were prognostic. In 75 % of patients, the ds-GPA score predicted short-term survival. Use of resection with focal radiotherapy (p < 0.001) and systemic treatment (p < 0.001) appeared prognostically favourable compared to whole brain radiotherapy (WBRT) alone. However, survival benefits were very modest, with a median gain of 6 weeks following resection and focal radiotherapy compared to whole-brain radiotherapy, and 3 weeks from systemic treatment. Systemic tumor progression was documented as the cause of death in the majority of patients. Over the examined time period, the ratio between STS and other patients remained without significant change.

Conclusion

Within STS, KPS and number of BM are of prognostic relevance. There is benefit from local and systemic therapy to a limited extent. Shared and carefully discussed individual therapy decisions are necessary.
脑转移的短期幸存者从局灶和全身治疗中获益不大,尽管治疗环境有所改善,但仍然频繁发生。
目的:增加脑转移(BM)患者的治疗选择。虽然这些在亚组中导致相当大的生存效应,但对BM和短生存期患者的特征、预后因素和治疗效果的了解有限。方法:分析2009-2021年间在大型三级癌症中心诊断为BM的生存时间≤6个月的患者(短期幸存者,STS)。记录临床和治疗特点、病理资料和死亡原因。进行描述性统计、治疗特异性单变量Kaplan-Meier估计分析和多变量Cox回归。结果:1248例BM患者中,有480例(38%)为STS。256例有详细临床记录的STS纳入本分析。在单因素和多因素分析中,Karnofsky性能状态(KPS) (p)结论:在STS范围内,KPS和BM数量与预后相关。局部和全身治疗在一定程度上是有益的。分享和仔细讨论个人治疗决定是必要的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Clinical and Translational Radiation Oncology
Clinical and Translational Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging
CiteScore
5.30
自引率
3.20%
发文量
114
审稿时长
40 days
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