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Brain metastasis

Prognostic value of the number of involved extracranial organs

Hirnmetastasen

Prognostische Bedeutung der Anzahl befallener extrakranieller Organe

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Abstract

Background and purpose

This study was performed to evaluate the prognostic role for survival of the number and the type of involved extracranial organs in patients with brain metastasis.

Material and methods

The data of 1146 patients who received whole-brain radiotherapy (WBRT) alone for brain metastasis have been retrospectively analyzed. In addition to the number of involved extra cranial organs, seven potential prognostic factors were investigated including WBRT regimen, age, gender, Karnofsky Performance Score (KPS), primary tumor type, number of brain metastases, and the interval from cancer diagnosis to WBRT. Additionally, subgroup analyses were performed for patients with involvement of one (lung vs. bone vs. liver vs. other metastasis) and two (lung + lymph nodes vs. lung + bone vs. lung + liver vs. liver + bone vs. other combinations) extracranial organs.

Results

The 6-month survival rates for the involvement of 0, 1, 2, 3, and ≥ 4 extracranial organs were 51, 30, 16, 13, and 10 %, respectively (p < 0.001). On multivariate analysis, the number of involved extracranial organs maintained significance (risk ratio 1.26; 95 % confidence interval 1.18–1.34; p < 0.001). According to the multivariate analysis, age (p < 0.001), gender (p = 0.002), and KPS (p < 0.001) were also independent prognostic factors for survival. In the subgroup analyses of patients with involvement of one and two extracranial organs, survival was not significantly different based on the extracranial organ involved.

Conclusion

The number of involved extracranial organs proved to be an independent prognostic factor in patients with brain metastasis, regardless of the organs involved. The number of involved extracranial organs should be considered in future trials designed for patients with brain metastasis.

Zusammenfassung

Hintergrund und Ziel

Diese Studie wurde durchgeführt, um die prognostische Bedeutung der Anzahl und der Art der befallenen extrakraniellen Organe für das Überleben von Patienten mit Hirnmetastasen zu evaluieren.

Material und Methoden

Die Daten von 1146 Patienten, die eine alleinige Ganzhirnbestrahlung (WBRT) bei Hirnmetastasen erhielten, wurden retrospektiv analysiert. Zusätzlich zu der Anzahl befallener extrakranieller Organe wurden 7 weitere Faktoren untersucht: WBRT-Regime, Alter, Geschlecht, Karnofsky-Performance-Score (KPS), Art des Primärtumors, Anzahl der Hirnmetastasen und Intervall von der Erstdiagnose der Tumorerkrankung bis zur WBRT. Subgruppenanalysen erfolgten für Patienten mit Befall von einem (Lunge vs. Knochen vs. Leber vs. andere) oder zwei (Lunge + Lymphknoten vs. Lunge + Knochen vs. Lunge + Leber vs. Leber + Knochen vs. andere Kombinationen) extrakraniellen Organen.

Ergebnisse

Die Überlebensraten nach 6 Monaten bei Befall von 0, 1, 2, 3 und ≥ 4 extrakraniellen Organen betrugen jeweils 51, 30, 16, 13 und 10 % (p < 0,001). In der multivariaten Analyse blieb die Anzahl der befallenen extrakraniellen Organe signifikant (Risk Ratio 1,26; 95 %-Konfidenzintervall 1,18–1,34; p < 0,001). Gemäß der Multivarianzanalyse waren auch Alter (p < 0,001), Geschlecht (p = 0,002) und KPS (P < 0,001) unabhängige Prognosefaktoren für das Überleben. In den Subgruppenanalysen der Patienten mit Befall von einem oder zwei extrakraniellen Organen war das Überleben nicht signifikant mit der Art der befallenen Organe assoziiert.

Schlussfolgerungen

Die Anzahl befallener extrakranieller Organe erwies sich als unabhängiger Prognosefaktor bei Patienten mit Hirnmetastasen, unabhängig von der Art der befallenen Organe. Die Anzahl befallener extrakranieller Organe sollte bei zukünftigen Studien von Patienten mit Hirnmetastasen berücksichtigt werden.

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Compliance with ethical guidelines

Conflict of interest. D. Rades, L. Gerdan, B. Segedin, V. Nagy, M.T. Khoa, N.T. Trang, and S.E. Schild state that there are no conflicts of interest.

The accompanying manuscript does not include studies on humans or animals.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany

    D. Rades M.D. & L. Gerdan

  2. Section of Nuclear Medicine, University of Lübeck, Lübeck, Germany

    L. Gerdan

  3. Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia

    B. Segedin

  4. Department of Radiotherapy, Oncology Institute Ion Ciricuta, Cluj-Napoca, Romania

    V. Nagy

  5. Department of Nuclear Medicine, Hanoi Medical University, Hanoi, Vietnam

    M.T. Khoa

  6. Nuclear Medicine and Oncology Center, Bach Mai Hospital, Hanoi, Vietnam

    M.T. Khoa & N.T. Trang

  7. Department of Radiation Oncology, Mayo Clinic Scottsdale, Scottsdale, AZ, USA

    S.E. Schild

Authors
  1. D. Rades M.D.
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  2. L. Gerdan
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  3. B. Segedin
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  4. V. Nagy
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  5. M.T. Khoa
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  6. N.T. Trang
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  7. S.E. Schild
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Corresponding author

Correspondence to D. Rades M.D..

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Rades, D., Gerdan, L., Segedin, B. et al. Brain metastasis. Strahlenther Onkol 189, 996–1000 (2013). https://doi.org/10.1007/s00066-013-0442-y

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  • DOI: https://doi.org/10.1007/s00066-013-0442-y

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