Is Whole-Brain Radiotherapy for Brain Metastases an Overestimated Therapy? A Retrospective Study of Real-World Data Using Landmark Analyses

IF 3.1 2区医学 Q2 ONCOLOGY Cancer Medicine Pub Date : 2024-12-20 DOI:10.1002/cam4.70522

Florian Hoelzl, Oliver Koelbl, Isabella Gruber

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Abstract

Background

The role of whole-brain radiotherapy for patients with brain metastases is changing as immunotherapy and molecularly targeted therapies advance. However, whole-brain radiotherapy continues to be part of the multimodal concept.

Methods

This retrospective study included 285 patients who received whole-brain radiotherapy for brain metastases, using a median dose of 30 Gy. The study analyzed prognostic factors for survival using Cox regression analyses, while two landmark analyses, reflecting a minimum survival of 60 and 90 days, accounted for early deaths. Neurological symptoms were compared before and after treatment using the McNemar test.

Results

The median patient age was 62 years. Non-small cell lung cancer (n = 95), breast cancer (n = 53), and small cell lung cancer (n = 48) were the most frequent cancer types. Median survival was 4.3 months (interquartile range 1.8–11.1). In the multivariable Cox regression model, patients who received additional immunotherapy/molecularly targeted therapy had a higher chance of survival than others. Overall survival was influenced by control of primary cancer, extracranial metastases, age, Karnofsky performance status, and number of brain metastases. The 90-day landmark analysis included 181 patients who survived at least 90 days, reflecting that 104 patients (36.5%) died within the first 90 days. The 90-day landmark analysis confirmed all predictive variables for survival. Patients who died before the 90-day landmark endpoint had more brain metastases, lower Karnofsky performance status, higher age, and were less frequently treated with immunotherapy/molecularly targeted therapy than those surviving at least 90 days. The treatment significantly improved neurological symptoms.

Conclusion

These results indicate an insufficient patient selection, as one-third of patients treated with whole-brain radiotherapy died within 90 days. However, neurological symptoms improved, and the addition of immunotherapy and/or molecularly targeted therapy to whole-brain radiotherapy was associated with better survival. Patients receiving whole-brain irradiation should be more carefully selected.

Trial Registration

ClinicalTrials: 24-3626-104

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全脑放疗治疗脑转移瘤是一种被高估的治疗方法吗？使用里程碑分析对真实世界数据进行回顾性研究。

背景：随着免疫治疗和分子靶向治疗的进展，全脑放疗在脑转移患者中的作用正在发生变化。然而，全脑放射治疗仍然是多模式概念的一部分。方法：本回顾性研究纳入285例接受全脑放疗治疗脑转移的患者，中位剂量为30 Gy。该研究使用Cox回归分析分析了影响生存的预后因素，而两项具有里程碑意义的分析（反映了60天和90天的最低生存期）解释了早期死亡。使用McNemar试验比较治疗前后的神经症状。结果：患者中位年龄为62岁。非小细胞肺癌（n = 95）、乳腺癌（n = 53）和小细胞肺癌（n = 48）是最常见的癌症类型。中位生存期为4.3个月（四分位数范围1.8-11.1）。在多变量Cox回归模型中，接受额外免疫治疗/分子靶向治疗的患者比其他患者有更高的生存机会。总生存率受原发癌控制、颅外转移、年龄、Karnofsky性能状态和脑转移数量的影响。90天里程碑分析包括181例存活至少90天的患者，反映出104例患者（36.5%）在前90天内死亡。90天的里程碑式分析证实了生存的所有预测变量。与存活至少90天的患者相比，在90天里程碑终点前死亡的患者有更多的脑转移，更低的Karnofsky表现状态，更高的年龄，更少的接受免疫治疗/分子靶向治疗。治疗显著改善了神经系统症状。结论：这些结果表明患者选择不足，因为三分之一的全脑放疗患者在90天内死亡。然而，神经系统症状得到改善，在全脑放疗中加入免疫治疗和/或分子靶向治疗与更好的生存率相关。接受全脑照射的患者应更仔细地选择。试验注册：ClinicalTrials: 24-3626-104。

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来源期刊

Cancer Medicine ONCOLOGY-

CiteScore

5.50

自引率

2.50%

发文量

907

审稿时长

19 weeks

期刊介绍： Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas: Clinical Cancer Research Translational research ∙ clinical trials ∙ chemotherapy ∙ radiation therapy ∙ surgical therapy ∙ clinical observations ∙ clinical guidelines ∙ genetic consultation ∙ ethical considerations Cancer Biology: Molecular biology ∙ cellular biology ∙ molecular genetics ∙ genomics ∙ immunology ∙ epigenetics ∙ metabolic studies ∙ proteomics ∙ cytopathology ∙ carcinogenesis ∙ drug discovery and delivery. Cancer Prevention: Behavioral science ∙ psychosocial studies ∙ screening ∙ nutrition ∙ epidemiology and prevention ∙ community outreach. Bioinformatics: Gene expressions profiles ∙ gene regulation networks ∙ genome bioinformatics ∙ pathwayanalysis ∙ prognostic biomarkers. Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.