Abstract
Introduction
Palliative WBRT is the main treatment for multiple BMs. Recent studies report no benefit in survival after WBRT compared to palliative supportive care in patients (pts) with poor prognosis. A new era of systemic treatment strategies based on targeted therapies are improving the prognosis of patients with BMs. The purpose of this study is to develop a prognostic score in palliative pts with BMs who undergo WBRT in this new setting.
Methods
239 pts with BMs who received palliative WBRT between 2013–2022 in our center were analyzed retrospectively. The score was designed according to the value of the β coefficient of each variable with statistical significance in the multivariate model using Cox regression. Once the score was established, a comparison was performed according to Kaplan–Meier and was analyzed by log-rank test.
Results
149 pts (62.3%) were male and median (m) age was 60 years. 139 (58,2%) were lung cancer and 35 (14,6%) breast cancer. All patients received 30Gys in 10 sessions. m overall survival (OS) was 3,74 months (ms). 37 pts (15,5%) had a specific target mutation. We found that 62 pts were in group < 4 points with mOS 6,89 ms (CI 95% 3,18–10,62), 84 in group 4–7 points with mOS 4,01 ms (CI 95% 3,40–4,62) and 92 pts in group > 7 points with mOS 2,72 ms (CI 95% 1,93–3,52) (p < 0,001).
Conclusions
METASNCore items are associated with OS and they could be useful to select palliative pts to receive WBRT. More studies are necessary to corroborate our findings.
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Data availability
No datasets were generated or analysed during the current study.
References
Dziggel L, Segedin B, Podvrsnik NH, Oblak I, Schild SE, Rades D (2013) Validation of a survival score for patients treated with whole-brain radiotherapy for brain metastases. Strahlenther Onkol 189(5):364–366
Schouten LJ, Rutten J, Huveneers HAM, Twijnstra A (2002) Incidence of brain metastases in a cohort of patients with carcinoma of the breast, colon, kidney, and lung and melanoma. Cancer 94(10):2698–2705
Priestman TJ, Dunn J, Brada M, Rampling R, Baker PG (1996) Final results of the Royal College of Radiologists’ trial comparing two different radiotherapy schedules in the treatment of cerebral metastases. Clin Oncol (R Coll Radiol) 8(5):308–315
Le Rhun E, Guckenberger M, Smits M, Dummer R, Bachelot T, Sahm F et al (2021) EANO–ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with brain metastasis from solid tumours. Ann Oncol 32(11):1332–1347
Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T et al (1997) Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials.Int J Radiat Oncol Biol Phys 37(4):745–751
Nieder C, Andratschke NH, Geinitz H, Grosu AL (2012) Use of the Graded Prognostic Assessment (GPA) score in patients with brain metastases from primary tumours not represented in the diagnosis-specific GPA studies. Strahlenther Onkol 188(8):692–695
Mulvenna P, Nankivell M, Barton R, Faivre-Finn C, Wilson P, McColl E et al (2016) 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. Lancet 388(10055):2004–2014
Vargas A, Conill C, Verger E (2018) El rol de la radioterapia holocraneal en los pacientes de mal pronóstico con metástasis cerebrales. Med Paliativa 25(2):61–65
Berghoff AS, Wolpert F, Holland-Letz T, Koller R, Widhalm G, Gatterbauer B et al (2017) Combining standard clinical blood values for improving survival prediction in patients with newly diagnosed brain metastases-development and validation of the LabBM score. Neuro Oncol 19(9):1255–1262
Nieder C, Dalhaug A, Pawinski A (2019) External validation of the LabBM score in patients with brain metastases. J Clin Med Res 11(5):321–325
Nieder C, Marienhagen K, Dalhaug A, Aandahl G, Haukland E, Pawinski A (2014) Prognostic models predicting survival of patients with brain metastases: integration of lactate dehydrogenase, albumin and extracranial organ involvement. Clin Oncol (R Coll Radiol) 26(8):447–452
Chiec L, Kumthekar P (2022) Targeting HER2+ breast cancer brain metastases: a review of brain-directed HER2-directed therapies. CNS Drugs 36(2):167–179
Marchand-Crety C, Riverain J, Drouet Y, Felici F, Jeandidier CL, Thariat J et al (2021) A new model outperforming RPA and DS-GPA scores for individualized survival prediction of patients following whole brain irradiation for brain metastasis. Cancer Radiother 25(5):447–456
Sperduto PW, Yang TJ, Beal K, Pan H, Brown PD, Bangdiwala A et al (2016) The effect of gene alterations and tyrosine kinase inhibition on survival and cause of death in patients with adenocarcinoma of the lung and brain metastases. Int J Radiat Oncol Biol Phys 96(2):406–413
Sperduto PW, Mesko S, Li J, Cagney D, Aizer A, Lin NU et al (2020) Survival in patients with brain metastases: summary report on the updated diagnosis-specific graded prognostic assessment and definition of the eligibility quotient. J Clin Oncol 38(32):3773–3784
Hou R, Li H, Cao J, Song X, Zhang X, Wang W (2021) Validation of a novel prognostic index: BMS-Score for patients with brain metastases of small cell lung cancer. Ann Palliat Med 10(1):29–36
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Flores-Paco, P., Vargas-Aliaga, A., Guevara, M.G. et al. A new updated prognostic index for patients with brain metastases (BMs) treated with palliative whole brain radiotherapy (WBRT) in the era of precision oncology. METASNCore project. J Neurooncol (2024). https://doi.org/10.1007/s11060-024-04618-1
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DOI: https://doi.org/10.1007/s11060-024-04618-1