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Brain metastases in patients under 50 years of age: retrospective analysis

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Abstract

Several previous publications suggested that younger patients with brain metastases have longer survival than older patients. However, detailed studies of younger patient groups are scarce. Therefore, a multi-institutional analysis of younger patients with brain metastases was performed (defined as adults with age <50 years). Prognostic factors for survival were examined by uni- and multivariate analyses and compared to those obtained in patients with age ≥50 years. Multivariate analysis of 106 patients (median age 44 years, range 23–49 years) revealed three independent prognostic factors for survival: performance status, extracranial metastases and primary tumor control. Survival was significantly better in patients treated after the year 2000 (median 9.4 months) as compared to those treated before the year 2000 (median 5.1 months, p = 0.04). This improvement appeared to be related to an increased use of surgery or radiosurgery (SRS) and decreasing numbers of patients with uncontrolled primary tumor. Irrespective of management approach, survival beyond 5 years was uncommon (actuarial rate 6 %; 17 % in patients treated with upfront surgery or SRS). In conclusion, more intense multidisciplinary approaches aiming at control both in the brain, extracranial metastatic sites, and primary tumor site might have contributed to gradual survival improvements in recent years. Nevertheless, further efforts are necessary to improve long-term survival.

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References

  1. Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, McKenna WG, Byhart R (1997) Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 37:745–751

    Article  PubMed  CAS  Google Scholar 

  2. Rades D, Dunst J, Schild SE (2008) A new scoring system to predicting the survival of patients treated with whole-brain radiotherapy for brain metastases. Strahlenther Onkol 184:251–255

    Article  PubMed  Google Scholar 

  3. Weltman E, Salvajoli JV, Brandt RA, de Hanriot Morais R, Prisco FE, Cruz JC, de Oliveira Borges SR, Wajsbrot DB (2000) Radiosurgery for brain metastases: a score index for predicting prognosis. Int J Radiat Oncol Biol Phys 46:1155–1161

    Article  PubMed  CAS  Google Scholar 

  4. Sperduto PW, Berkey B, Gaspar LE, Mehta M, Curran W (2008) A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1,960 patients in the RTOG database. Int J Radiat Oncol Biol Phys 70:510–514

    Article  PubMed  Google Scholar 

  5. Sperduto PW, Kased N, Roberge D, Xu Z, Shanley R, Luo X, Sneed PK, Chao ST, Weil RJ, Suh J, Bhatt A, Jensen AW, Brown PD, Shih HA, Kirkpatrick J, Gaspar LE, Fiveash JB, Chiang V, Knisely JP, Sperduto CM, Lin N, Mehta M (2012) Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases. J Clin Oncol 30:419–425

    Article  PubMed  Google Scholar 

  6. Nieder C, Spanne O, Mehta MP, Grosu AL, Geinitz H (2010) Presentation, patterns of care, and survival in patients with brain metastases: what has changed in the last 20 years? Cancer 117:2505–2512

    Article  Google Scholar 

  7. Nieder C, Norum J, Stemland JG, Dalhaug A (2010) Resource utilization in patients with brain metastases managed with best supportive care, radiotherapy and/or surgical resection: a Markov analysis. Oncology 78:348–355

    Article  PubMed  Google Scholar 

  8. Lorenzoni J, Devriendt D, Massager N, David P, Ruiz S, Vanderlinden B, Van Houtte P, Brotchi J, Levivier M (2004) Radiosurgery for treatment of brain metastases: estimation of patient eligibility using three stratification systems. Int J Radiat Oncol Biol Phys 60:218–224

    Article  PubMed  Google Scholar 

  9. Sperduto PW, Chao ST, Sneed PK, Luo X, Suh J, Roberge D, Bhatt A, Jensen AW, Brown PD, Shih H, Kirkpatrick J, Schwer A, Gaspar LE, Fiveash JB, Chiang V, Knisely J, Sperduto CM, Mehta M (2010) Diagnosis-specific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multi-institutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys 77:655–661

    Article  PubMed  Google Scholar 

  10. Lutterbach J, Bartelt S, Momm F, Becker G, Frommhold H, Ostertag C (2005) Is older age associated with a worse prognosis due to different patterns of care? Cancer 103:1234–1244

    Article  PubMed  Google Scholar 

  11. Nieder C, Thamm R, Astner ST, Geinitz H, Molls M (2007) Is whole-brain radiotherapy effective and safe in elderly patients with brain metastases? Oncology 72:326–329

    Article  PubMed  Google Scholar 

  12. Rades D, Evers JN, Veninga T, Stalpers LJ, Lohynska R, Schild SE (2011) Shorter-course whole-brain radiotherapy for brain metastases in elderly patients. Int J Radiat Oncol Biol Phys 81:e467–e473

    Google Scholar 

  13. Assouline A, Levy A, Chargari C, Lamproglou I, Mazeron JJ, Krzisch C (2011) Whole brain radiotherapy: prognostic factors and results of a radiation boost delivered through a conventional linear accelerator. Radiother Oncol 99:214–217

    Article  PubMed  Google Scholar 

  14. Karlsson B, Hanssens P, Wolff R, Södermann M, Lindquist C, Beute G (2009) Thirty years’ experience with gamma knife surgery for metastases to the brain. J Neurosurg 111:449–457

    Article  PubMed  Google Scholar 

  15. Andrews DW, Scott CB, Sperduto PW, Flanders AE, Gaspar LE, Schell MC, Werner-Wasik M, Demas W, Ryu J, Bahary JP, Souhami L, Rotman M, Mehta MP, Curran WJ Jr (2004) Whole brain radiation therapy with and without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomized trial. Lancet 363:1665–1772

    Article  PubMed  Google Scholar 

  16. Noordijk EM, Vecht CJ, Haaxma-Reiche H, Padberg GW, Voormolen JH, Hoekstra FH, Tans JT, Lambooij N, Metsaars JA, Wattendorf AR (1994) The choice of treatment of single brain metastasis should be based on extracranial tumor activity. Int J Radiat Oncol Biol Phys 29:711–717

    Article  PubMed  CAS  Google Scholar 

  17. Patchell RA, Tibbs PA, Walsh JW, Dempsey RJ, Maruyama Y, Kryscio RJ, Markesberry WR, Macdonald JS, Young B (1990) A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 322:494–500

    Article  PubMed  CAS  Google Scholar 

  18. Kalkanis SN, Kondziolka D, Gaspar LE, Burri SH, Asher AL, Cobbs CS, Ammirati M, Robinson PD, Andrews DW, Loeffler JS, McDermott M, Mehta MP, Mikkelsen T, Olson JJ, Paleologos NA, Patchell RA, Ryken TC, Linskey ME (2010) The role of surgical resection in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol 96:33–43

    Article  PubMed  Google Scholar 

  19. Linskey ME, Andrews DW, Asher AL, Burri SH, Kondziolka D, Robinson PD, Ammirati M, Cobbs CS, Gaspar LE, Loeffler JS, McDermott M, Mehta MP, Mikkelsen T, Olson JJ, Paleologos NA, Patchell RA, Ryken TC, Kalkanis SN (2010) The role of stereotactic radiosurgery in the management of patients with newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol 96:45–68 (Erratum in: J Neurooncol 96:69–70)

    Article  PubMed  Google Scholar 

  20. Mehta MP, Paleologos NA, Mikkelsen T, Robinson PD, Ammirati M, Andrews DW, Asher AL, Burri SH, Cobbs CS, Gaspar LE, Kondziolka D, Linskey ME, Loeffler JS, McDermott M, Olson JJ, Patchell RA, Ryken TC, Kalkanis SN (2010) The role of chemotherapy in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol 96:71–83

    Article  PubMed  Google Scholar 

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Oncology and Palliative Medicine, Nordland Hospital, 8092, Bodø, Norway

    Carsten Nieder

  2. Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, 9038, Tromsø, Norway

    Carsten Nieder

  3. Department of Radiation Oncology, University Hospital Freiburg, 79106, Freiburg, Germany

    Anca L. Grosu

  4. Department of Oncology, University Hospital of Northern Norway, 9037, Tromsø, Norway

    Oddvar Spanne

  5. Department of Radiation Oncology, University Hospital Rostock, 18057, Rostock, Germany

    Nicolaus H. Andratschke

  6. Department of Radiation Oncology, Klinikum Rechts der Isar der Technischen Universität München, 81675, Munich, Germany

    Hans Geinitz

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  1. Carsten Nieder
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  2. Anca L. Grosu
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  3. Oddvar Spanne
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  4. Nicolaus H. Andratschke
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  5. Hans Geinitz
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Correspondence to Carsten Nieder.

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Nieder, C., Grosu, A.L., Spanne, O. et al. Brain metastases in patients under 50 years of age: retrospective analysis. Clin Exp Metastasis 29, 949–956 (2012). https://doi.org/10.1007/s10585-012-9484-2

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  • DOI: https://doi.org/10.1007/s10585-012-9484-2

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