Sunday, March 3, 2024

Life Expectancy After Whole Brain Radiation

Conflict Of Interest Statement

Study of Whole-Brain Radiation vs. Stereotactic Radiation for Patients with 5-20 Brain Metastases

The authors declare that they have no actual or potential conflicts of interest. No payments or services were received from a third party for any aspect of the submitted work. No financial relationships with entities that could be perceived to influence, or that give the appearance of potentially influencing, the work submitted need to be declared. No other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, the submitted work needs to be declared.

Short Survival Time After Palliative Whole Brain Radiotherapy: Can We Predict Potential Overtreatment By Use Of A Nomogram

Carsten Nieder1, 2, Jan Norum2, 3, Mandy Hintz4, Anca L. Grosu4, 5

1. Department of Oncology and Palliative Medicine, Nordland Hospital, 8092 Bodø, Norway 2. Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, 9037 Tromsø, Norway 3. Northern Norway Regional Health Authority trust, 8038 Bodø, Norway 4. Department of Radiation Oncology, University Hospital Freiburg, 79106 Freiburg, Germany 5. German Cancer Consortium , Freiburg, and German Cancer Research Centre , D-69121 Heidelberg, Germany.

Corresponding author: Carsten Nieder, MD, Department of Oncology and Palliative Medicine, Nordland Hospital, 8092 Bodø, Norway, Tel: +47 75 57 8449, FAX: +47 75 53 4975, e-mail: carsten.niederno

Citation:J Cancer

Wbrt As First Choice Of Treatment In Patients With Brain Metastases From Solid Tumors

WBRT was the standard treatment for most patients with BM. Today WBRT is indicated for patients with poor prognosis if BM are unsuitable for radiosurgery or surgery. According to the European Association of Neuro-Oncology guidelines on brain metastases from solid tumors, WBRT in combination with corticosteroids is recommended in patients with multiple brain metastases or presenting with uncontrolled primary tumor or multiple extracerebral metastases, if they are symptomatic . Upfront WBRT remains a standard approach for patients with multiple brain metastases even though the Quality of Life after Treatment for Brain Metastases trial cannot assert the advantage of WBRT plus best supportive care compared with best supportive care alone in patients .

Median survival following WBRT alone ranges from 3 to 6 months, with 1015% of patients alive at 1 year . Various fractionation schedules may be used . None has proven superiority in terms of prolonging OS or better neurologic function or symptom control described in a meta-analysis of 39 trials by Tsao et al. .

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Combined Immunotherapy And Radiotherapy

The rationale behind the combination of the immunotherapy was derived from abscopal effect. Abscopal effect refers to the phenomenon that treatment of the local tumor leads to the concurrent shrinkage of the metastatic tumor at distant sites. The hypothesis is that radiation leads to the death of tumor and thus the liberation of tumor-associated antigens . These antigens can be recognized and processed by the antigen-presenting cells. Then, cytotoxic T cells can be primed to target the tumor cells at distant areas.

Combining radiotherapy with immunotherapy provides opportunities for boosting abscopal response rate and further use of radiotherapy for local and metastatic tumors .

Several studies had been conducted to investigate the efficacy and safety of the combination of immunotherapy and radiotherapy for brain metastases.

One study proved that the concurrent use of immunotherapy and SRS resulted in appreciable reduction in lesion volume . A total of 75 patients with 566 melanoma brain metastases was included. The reduction in lesion was significantly greater for the concurrent group than the non-concurrent group at 1.5months, 3months, and 6months. The overall survival of patients with concurrent modality is longer than that of patients who received SRS only. In addition, the reduction of the lesion in the modality with PD-1 inhibitor was greater than that of the modality with CTLA-4 inhibitor.

Wbrt In Combination With Srs Or Surgery

Efficiency and prognosis of whole brain irradiation combined with ...

WBRT leads to an improved outcome in patients with single metastases, including improved overall survival, less development of new brain relapses and longer duration of functional independence . Patients with brain oligometastases showed no improvement with combined treatment of WBRT and SRS. Studies compared WBRT plus SRS with SRS alone . Overall survival after combined treatment did not differ from SRS alone, only the distant brain metastases were more frequent in patients treated with SRS alone. Adjuvant WBRT following surgery increases local control and reduces distant relapses in patients with brain metastases > 3cm. Regardless which kind of combination is performed WBRT increases the risk of neurocognitive decline, transient lower physical functioning and more fatigue. Based on these results, the American Society for Radiation Oncology does not recommend a combination of SRS and WBRT routinely in patients with limited BMs, but to perform frequent MRI surveillance.

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Cost And Financing Analysis

The trial is based on two therapeutic approaches accepted as evidence-based medicine and can be proposed to a specific population affected by metastatic cancer. This study does not involve additional costs, other than those already included in normal clinical practice. The investigators will receive no financial support and declare no conflict of interest.

Xiii Role Of The Funder

This project was commissioned and funded by the Patient-Centered Outcomes Research Institute and executed under Contract No. 290-2015-00009-I from the Agency for Healthcare Research and Quality, U.S. Department of Health and Human Services. The AHRQ Task Order Officer reviewed the EPC response to contract deliverables for adherence to contract requirements and quality. The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by PCORI, the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.

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Treatment Completion And Planned Fractionation

Among 50 patients who did not complete RT as planned, mean time from RT to death was 19 days 32% dying within 14 days and 39% within 30 days of RT did not complete treatment as planned. Reasons for incomplete treatment were death in 42%, deterioration in 34%, and patient preference in 14% 1 patient ceased treatment due to disease progression.

Of those whose last treatment was WBRT, 363 were planned for 10 fractions and 121 for 5. Mean time from RT to death was shorter when 5 vs. 10 fractions were planned .

While the maximum number of planned WBRT fractions was 15 among those with internal RO providers, 10 of 129 patients with external RO providers were planned for 1625 fractions. Though at external RO facilities, the number of planned fractions was higher and patients less likely to complete RT as planned , the number of deaths during treatment and near the EOL was not significantly different from those treated within the healthcare system on multivariate analysis.

Surgical Resection Plus Wbrt

Risks of whole brain radiation therapy outweigh benefits for patients with limited brain metastases

Several clinical trials investigated the superiority of surgical resection plus WBRT against surgery or WBRT alone.

Surgical resection plus WBRT versus WBRT alone

Two prospective randomized trials compared the surgical resection plus WBRT versus WBRT alone . Vecht et al. enrolled 63 eligible patients with a single brain metastasis in their clinical trial, who were randomized assigned with surgery plus WBRT or WBRT alone. All of the patients were prescribed with the same schedule of WBRT. The combined therapy led to longer overall survival and functionally independent survival. Patients with combined modality also benefited from immediate functional improvement. However, another clinical trial failed to demonstrate the benefit of additional surgery to WBRT. There is no significant difference between the overall survival, mortality, and morbidity rate or cause of death of the patients in two groups.

Surgical resection plus WBRT versus surgical resection alone

In 1998, the result of a randomized clinical trial established the status of postoperative WBRT as the standard care for patients with brain metastases . A total of 95 patients with a single brain metastasis were enrolled and randomly assigned to two groups. Postoperative WBRT decreases the rate of both local and distant recurrence, and the incidence of death from neurological death. However, there is no difference between the overall survival among the two groups of patients.

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Quality Of Life Evaluation

The Romanian version of EORTC QLQ-C30 and QLQ-BN20 questionnaires was applied to patients at baseline and at the end of treatment.

The QLQ-C30 questionnaire has 30 items and it is used to evaluate a wide range of symptoms and endpoints in oncologic patients. It comprises 5 functional domains which investigate the social, cognitive, physical, emotional aspects, role functioning and the global health status. In addition, there are 3 symptom domains, 5 singular symptom items and an item investigating the financial difficulties. Each item receives a score from 1 to 4, 1 being not at all, 2- a little, 3- quite a bit and 4- very much. The 2 questions from the global health status domain have scores from 1 to 7 . The QLQ-BN20 questionnaire contains 20 items, comprising 4 symptom domains and 7 singular symptom items.

For both questionnaires the raw scores were computed, after which the linear transformation was applied, according to the EORTC scoring manual . On a scale from 0 to 100, a higher score on a symptom item corresponds to worse symptoms, whereas in functional domains higher scores are favorable.

Good News For Patients With Brain Metastases

This post is available in: Spanish

When cancer spreads to the brainfrom a different part of the body, historically life expectancy has beengenerally poor. In addition, its been difficult for doctors to predictsurvivability. But thanks to groundbreaking work in a three-country study thatincluded MiamiCancer Institute, all of that is changing.

Doctors at the Institute, along with those at 17 other cancer centers in the United States, Canada and Japan, have determined that survival rates for patients with brain metastases are improving, making many eligible for clinical trials and innovative treatments that they would have been previously excluded from. In addition, the researchers developed an algorithm that very accurately predicts prognosis.

Weve found that there are subcategories of patients who have substantially better survival were talking survival in years compared to months, said Minesh Mehta, M.D., deputy director and chief of radiation oncology at Miami Cancer Institute. No longer does one need to speculate or guess to make a prediction on a brain metastases patients survival.

If we recognize that thesepatients can have better survival and enroll them on these trials, we might infact identify newer agents that are more effective, Dr. Mehta said.

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I Background And Objectives For The Systematic Review

The development of secondary malignant growths has particular implications when cancer metastasizes to the brain. The management of brain metastases is challenging due to the effects of the disease and treatment on patients. The planned systematic review will determine the effects of radiation therapy to treat brain metastases.

Brain metastases are a common problem in cancer care, occurring in 10 to 30 percent of adult patients.1 The apparent incidence of brain metastases is increasing as diagnostic tools are refined and advances in systemic therapy that improve survival may also be leading to an actual increase.2,3 The development of brain metastases may have substantial prognostic implications by causing neurologic symptoms or death.

Historically, patients with brain metastases had a poor prognosis, and little thought was given to determining each individual’s prognosis and optimal treatment.4 However, the patient population affected by brain metastases is heterogeneous, and recent studies have shown that prognosis can vary substantially.58 Brain metastases occur with a variety of cancers, which may have different subtypes or molecular profiles that respond differently to treatment.3 Primary tumors that most commonly metastasize to the brain are lung cancer , breast cancer , and melanoma this systematic review will focus on these primary cancer types.3

Evaluation Of Neurologic Function And Symptoms

Radiosurgery or Fractionated Stereotactic Radiotherapy plus Whole

In 23 studies , a measure of the neurologic function and symptoms of the patients was reported. Various versions of a neurologic functional classification or scale was used in 20 reports. Bezjak et al.71 modelled an assessment tool after symptom items included in the fact-br and the bcm 20. This patient-rated assessment tool consisted of 16 items specific to patients with brain metastases. Symptoms were subdivided into raised intracranial pressure , effects associated with steroid use , possible subacute side effects , and effects associated with brain metastases . Robinet et al.7 used the order classification to record the neurologic status of the patients.

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Treatment Of Bm With Synchronous Presentation

BM that occur synchronously with primary diagnosis of SCLC represent different clinical scenarios and require different management compared with BM that are diagnosed metachronously, that is, at the relapse of SCLC. We may distinguish four categories of this synchronous presentation that require different management.

Radiation Therapy For A Metastatic Brain Tumor: 3 Things You Should Know

You may have been told that radiation therapy is your best treatment optionfor ametastatic brain tumor, also referred to as metastatic brain cancer. If youre worried about theside effects of radiation therapy, youre not alone.

Johns Hopkins neurosurgeonMichael Lim, M.D.,of theJohns Hopkins Comprehensive Brain Tumor Centerhears these concerns often. Heres what he wants you to know aboutradiation therapy for brain metastases:

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Viii Review Of Key Questions

The Agency for Healthcare Research and Quality posted the Key Questions on the AHRQ Effective Health Care Website for public comment. The Evidence-based Practice Center refined and finalized the Key Questions after review of the public comments and seeking input from Key Informants and the Technical Expert Panel . This input was intended to ensure that the key questions are specific and relevant.

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The Brain Mets Journey | Whole Brain Radiation and Cyberknife Results

It was one of three studies discussed Sunday at an American Society of Clinical Oncology conference in Chicago.

An estimated 400,000 patients in the United States alone each year have cancer that spreads to the brain, usually from the lungs, breast or other sites.

That is different from tumors that start in the brain, like the one that just killed Joseph R. “Beau” Biden III, the vice president’s son.

Cancer that spreads to the brain is usually treated with radiosurgery – highly focused radiation with a tool such as the Gamma Knife, followed by less intense radiation to the whole brain. The latter treatment can cause hair loss, dry mouth, fatigue and thinking problems.

Dr. Paul Brown of the University of Texas MD Anderson Cancer in Houston led a study of 213 patients with one to three tumors in the brain to see whether the risks of whole brain radiation were worth its help in controlling cancer.

Half of the patients had the usual radiosurgery and the rest had that followed by whole brain radiation. Three months later, 92 percent of patients who got both treatments had cognitive decline versus 64 percent of those given just radiosurgery.

“The negative effects far outweigh any benefits” of the combo treatment, Brown said.

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Radiotherapy Of Brain Metastases From Small

Warsaw 04-141, Poland .

Correspondence Address: Dr. Lucyna Kepka. Department of Radiation Oncology Military Institute of Medicine, Warsaw 04-141, Poland. E-mail:

Received:First Decision:Revised:Accepted:Science Editor:Copy Editor:Production Editor:

© The Author 2019. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License , which permits unrestricted use, sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long as you give appropriate credit to the original author and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Life Expectancy For Brain Metastases

Life expectancy in patients with brain metastases depends upon the variety of factors. It depends upon the stage at which the cancer is diagnosed. It also depends upon the type of primary cancer and its spread in other body parts. The life expectancy also depends upon the number of brain metastatic sites.

The complications related to brain metastases further depends upon the neurological damage due to tumor. Although various treatments are available for the management of brain metastases but none of the treatment completely cure the disease due to various reasons. Chemotherapy is rarely effective due to the fact that most of the chemotherapeutic drugs unable to cross the blood brain barrier at required concentration. Surgery of brain tumor is highly complicated and requires precision. Also, the patient and relative fears with surgery due to significant risk involved. Even if the risk of brain surgery is taken, most of the times the tumor cannot be completely removed due to its inaccessibility.

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New Brain Metastases Guidelines To Improve Care Patient Survival

UVA Cancer Center’s David Schiff, MD, co-chaired a blue-ribbon panel that developed new guidelines for the treatment of brain metastases.

New guidelines for treating cancers that have spread to the brain are poised to improve care for patients and help many live longer, better lives.

The new guidelines come from an expert panel assembled by the American Society of Clinical Oncology . The panel included a diverse range of top cancer doctors, including UVA Cancer Centers David Schiff, MD, as well as a patient representative.

The guidelines speak to the massive advances in care for brain metastases over the last few decades. Attempts to develop guidelines in the 1970s largely emphasized steroids and whole-brain radiation therapy, without controlled, randomized studies to guide the use of surgery and chemotherapy.

The new guidelines are far more encompassing and far more evidence-based. They will help doctors and patients make the best treatment decisions and achieve the best outcomes.

Wbrt As Prophylactic Cranial Irradiation


Prophylactic cranial irradiation in small cell lung cancer is still the gold standard for patients with limited tumor progression or with very good treatment response and stable extracranial disease after chemotherapy. Auperin et al. in 1999 performed a meta-analysis of 7 studies comprising 987 patients. They found that PCI showed an improvement in the 3year OS of 5.4% . The results of this meta-analysis could not be confirmed in a prospective MRI-based phase III study by Takahashi et al. . New treatment concepts are under evaluation recommending close monitoring by MRI controls in compliant patients and local SRS in case of single or oligometastases.

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