Real-world data on patterns and outcomes of radiation therapy for brain metastases in a population-based cohort of lung cancer patients in Victoria.
30-day mortality
brain metastases
lung cancer
stereotactic radiosurgery
whole-brain radiation therapy
Journal
Journal of medical imaging and radiation oncology
ISSN: 1754-9485
Titre abrégé: J Med Imaging Radiat Oncol
Pays: Australia
ID NLM: 101469340
Informations de publication
Date de publication:
Aug 2023
Aug 2023
Historique:
received:
02
01
2023
accepted:
21
05
2023
medline:
24
8
2023
pubmed:
5
6
2023
entrez:
5
6
2023
Statut:
ppublish
Résumé
We evaluated real-world data on the patterns and outcomes of radiotherapy (RT) for brain metastases (BM) in a population-based cohort of patients with lung cancer (LC) in Victoria. The Victorian Radiotherapy Minimum Data set (VRMDS) and the Victorian Cancer Registry (VCR) were linked to identify patients with LC who underwent RT for BM between 2013 and 2016. We determined: (i) proportion of patients treated with stereotactic radiosurgery (SRS); (ii) overall survival (OS); and (iii) 30-day mortality (30M) following RT for BM. Of the 1001 patients included in the study, 193 (19%) had SRS. There was no significant increase in SRS use over time - from 18% in 2013 to 21% in 2016 (P-trend = 0.8). In multivariate analyses, increased age (P = 0.03) and treatment in regional centres (P < 0.001) were independently associated with lower likelihood of SRS treatment. The median OS following RT for BM was 3.6 months. Patients who had SRS had better OS than those who did not have SRS (median OS 8.9 months vs. 3 months, P < 0.01). SRS use, age, sex and year of treatment were independently associated with OS in multivariate analyses. A total of 184 (18%) patients died within 30 days of RT for BM, and the proportion was higher in older (P = 0.001) and male patients (P = 0.004). One-in-five LC patients who received RT for BM had SRS. The improved OS with SRS is likely confounded by patient selection. It is important to reduce 30M by better selecting patients who may not benefit from RT for BM.
Identifiants
pubmed: 37272446
doi: 10.1111/1754-9485.13545
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
546-555Subventions
Organisme : Avant Foundation
Informations de copyright
© 2023 The Authors. Journal of Medical Imaging and Radiation Oncology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Radiologists.
Références
Nayak L, Lee EQ, Wen PY. Epidemiology of brain metastases. Curr Oncol Rep 2012; 14: 48-54.
Hanna NH, Schneider BJ, Temin S et al. Therapy for stage IV non-small-cell lung cancer without driver alterations: ASCO and OH (CCO) joint guideline update. J Clin Oncol 2020; 38: 1608-32.
Tsao MN, Xu W, Wong RK et al. Whole brain radiotherapy for the treatment of newly diagnosed multiple brain metastases. Cochrane Database Syst Rev 2018; 1: CD003869.
Andrews DW, Scott CB, Sperduto PW et al. Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet 2004; 363: 1665-72.
Brown PD, Jaeckle K, Ballman KV et al. Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial. JAMA 2016; 316: 401-9.
Chang EL, Wefel JS, Hess KR et al. Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol 2009; 10: 1037-44.
Soffietti R, Kocher M, Abacioglu UM et al. A European Organisation for Research and Treatment of Cancer phase III trial of adjuvant whole-brain radiotherapy versus observation in patients with one to three brain metastases from solid tumors after surgical resection or radiosurgery: quality-of-life results. J Clin Oncol 2013; 31: 65-72.
Yamamoto M, Serizawa T, Shuto T et al. Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study. Lancet Oncol 2014; 15: 387-95.
Magnuson WJ, Lester-Coll NH, Wu AJ et al. Management of brain metastases in tyrosine kinase inhibitor-naive epidermal growth factor receptor-mutant non-small-cell lung cancer: a retrospective multi-institutional analysis. J Clin Oncol 2017; 35: 1070-7.
Mulvenna P, Nankivell M, Barton R et al. Dexamethasone and supportive care with or without whole brain radiotherapy in treating patients with non-small cell lung cancer with brain metastases unsuitable for resection or stereotactic radiotherapy (QUARTZ): results from a phase 3, non-inferiority, randomised trial. Lancet 2016; 388: 2004-14.
Spencer K, Morris E, Dugdale E et al. 30 day mortality in adult palliative radiotherapy - a retrospective population based study of 14,972 treatment episodes. Radiother Oncol 2015; 115: 264-71.
Kain M, Bennett H, Yi M, Robinson B, James M. 30-day mortality following palliative radiotherapy. J Med Imaging Radiat Oncol 2020; 64: 570-9.
Ryoo JJ, Batech M, Zheng C et al. Radiotherapy for brain metastases near the end of life in an integrated health care system. Ann Palliat Med 2017; 6 (Suppl 1): S28-38.
Guadagnolo BA, Liao KP, Elting L, Giordano S, Buchholz TA, Shih YC. Use of radiation therapy in the last 30 days of life among a large population-based cohort of elderly patients in the United States. J Clin Oncol 2013; 31: 80-7.
Kutzko JH, Dadwal P, Holt T, Rahman MA, Zahir SF, Hickey B. Defining the expected 30-day mortality for patients undergoing palliative radiotherapy: a meta-analysis. Radiother Oncol 2022; 168: 147-210.
Ong WL, Wada M, Ruben J, Foroudi F, Millar J. Contemporary practice patterns of stereotactic radiosurgery for brain metastasis: a review of published Australian literature. J Med Imaging Radiat Oncol 2019; 63: 711-20.
Ong WL, Kang TMJ, Ratnayake G et al. Stereotactic radiosurgery for managing brain metastases in Victoria, 2012-2017. Med J Aust 2020; 212: 526-7.
Halasz LM, Weeks JC, Neville BA, Taback N, Punglia RS. Use of stereotactic radiosurgery for brain metastases from non-small cell lung cancer in the United States. Int J Radiat Oncol Biol Phys 2013; 85: e109-16.
Modh A, Doshi A, Burmeister C, Elshaikh MA, Lee I, Shah M. Disparities in the use of single-fraction stereotactic radiosurgery for the treatment of brain metastases from non-small cell lung cancer. Cureus 2019; 11: e4031.
Schlijper R, Fraser IM, Regan J, Lefresne S, Ho C, Olson RA. Patterns of radiotherapy utilization for lung cancer patients with brain metastases: a population-based analysis. Cureus 2019; 11: e5591.
Hodgson DC, Charpentier AM, Cigsar C et al. A multi-institutional study of factors influencing the use of stereotactic radiosurgery for brain metastases. Int J Radiat Oncol Biol Phys 2013; 85: 335-40.
Kann BH, Park HS, Johnson SB, Chiang VL, Yu JB. Radiosurgery for brain metastases: changing practice patterns and disparities in the United States. J Natl Compr Canc Netw 2017; 15: 1494-502.
Sperduto PW, De B, Li J et al. Graded prognostic assessment (GPA) for patients with lung cancer and brain metastases: initial report of the small cell lung cancer GPA and update of the non-small cell lung cancer GPA including the effect of programmed death ligand 1 and other prognostic factors. Int J Radiat Oncol Biol Phys 2022; 114: 60-74.
Jiang W, Haque W, Verma V, Butler B, Teh BS. Stereotactic radiosurgery for brain metastases from newly diagnosed small cell lung cancer: practice patterns and outcomes. Acta Oncol 2019; 58: 491-8.
Magnuson WJ, Yeung JT, Guillod PD, Gettinger SN, Yu JB, Chiang VL. Impact of deferring radiation therapy in patients with epidermal growth factor receptor-mutant non-small cell lung cancer who develop brain metastases. Int J Radiat Oncol Biol Phys 2016; 95: 673-9.
Robin TP, Jones BL, Amini A et al. Radiosurgery alone is associated with favorable outcomes for brain metastases from small-cell lung cancer. Lung Cancer 2018; 120: 88-90.
Wegner RE, Hasan S, Williamson RW et al. Management of brain metastases from large cell neuroendocrine carcinoma of the lung: improved outcomes with radiosurgery. Acta Oncol 2019; 58: 499-504.
Sahgal A, Aoyama H, Kocher M et al. Phase 3 trials of stereotactic radiosurgery with or without whole-brain radiation therapy for 1 to 4 brain metastases: individual patient data meta-analysis. Int J Radiat Oncol Biol Phys 2015; 91: 710-7.
Ragavan M, Patel MI. The evolving landscape of sex-based differences in lung cancer: a distinct disease in women. Eur Respir Rev 2022; 31: 210100.
Szumacher E, Sattar S, Neve M et al. Use of comprehensive geriatric assessment and geriatric screening for older adults in the radiation oncology setting: a systematic review. Clin Oncol (R Coll Radiol) 2018; 30: 578-88.
Gaebe K, Li AY, Park A et al. Stereotactic radiosurgery versus whole brain radiotherapy in patients with intracranial metastatic disease and small-cell lung cancer: a systematic review and meta-analysis. Lancet Oncol 2022; 23: 931-9.
Rusthoven CG, Yamamoto M, Bernhardt D et al. Evaluation of first-line radiosurgery vs whole-brain radiotherapy for small cell lung cancer brain metastases: the FIRE-SCLC cohort study. JAMA Oncol 2020; 6: 1028-37.