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Radiotherapy or systemic therapy versus combined therapy in patients with brain metastases: a propensity-score matched study

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Abstract

Aim

This study aimed to evaluate the clinical benefits of systemic therapy (ST) combined with stereotactic radiosurgery (SRS) for brain metastases (BM).

Methods

The patient data were extracted from the institutional disease database from 2016 to 2021. Surgical and whole-brain radiotherapy cases and poor Karnofsky performance status (KPS < 70) were excluded. The eligible patients were divided into monotherapy (SRS alone or ST alone) and combined therapy (SRS and ST, combined within a month). Univariate and multivariate Cox proportional hazards analyses were used to examine factors associated with increased risk of death and intracranial progression. The propensity score for selecting treatment was calculated based on existing prognostic covariates. Two groups were matched 1:1 and compared for intracranial progression-free survival (PFS) and overall survival (OS).

Results

We identified 1605 patients and analyzed 928 (monotherapy: n = 494, combined therapy: n = 434). In a multivariable model, the combined therapy was independently associated with improved PFS and OS relative to the monotherapy. At the median follow-up of 383 days in the matched dataset, the combined therapy group showed significantly longer PFS (median, 7.4 vs. 5.0 months, P < 0.001) and OS (median, 23.1 vs. 17.2 months, P = 0.036) than the monotherapy group. The overall intracranial progression and mortality risk was reduced in the combined therapy group, with an estimated HR of 0.70 and 0.78.

Conclusions

Combined therapy exhibited longer PFS and OS than monotherapy in BM patients. The results support the recent trend toward combining systemic and local therapies, encouraging future clinical trials.

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Data availability

Research data are stored in an institutional repository and anonymized numerical data will be shared upon request to the corresponding author. Research image data are not available at this time.

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Acknowledgements

The authors thank all the patients, investigators, and institutions involved in this study.

Funding

YK has received research funding from JSPS (Grant Number 20K16402), Aichi Cancer Research Foundation, and The Hori Science and Arts Foundation.

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Authors and Affiliations

  1. Department of Radiation Oncology, Aichi Cancer Center Hospital, Kanokoden 1–1, Chikusa-ku, Nagoya, Japan

    Yutaro Koide, Naoya Nagai, Risei Miyauchi, Tomoki Kitagawa, Takahiro Aoyama, Hidetoshi Shimizu, Hiroyuki Tachibana & Takeshi Kodaira

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  1. Yutaro Koide
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Contributions

YK collected the data and wrote the main manuscript. NN, RM, TK, TA, HS, HT, TK collected the data and supervised the study. All authors reviewed and approved the final manuscript.

Corresponding author

Correspondence to Yutaro Koide.

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Competing interest

YK has received research funding from JSPS, Aichi Cancer Research Foundation, and The Hori Science and Arts Foundation. TK has speaker bureau from Hitachi Co., Bristle Myers Squibb., Accuray Co., Elekta Co., Ono Pharmaceutical Co., AstraZeneca Co., Taiho Pharmaceutical Co., Canon Co., and Janssen Pharmaceutical Co.

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Koide, Y., Nagai, N., Miyauchi, R. et al. Radiotherapy or systemic therapy versus combined therapy in patients with brain metastases: a propensity-score matched study. J Neurooncol 160, 191–200 (2022). https://doi.org/10.1007/s11060-022-04132-2

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