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A cure is possible: a study of 10-year survivors of brain metastases

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Abstract

Little is known on the natural history, recurrence patterns, neurocognitive outcomes and prognostic factors associated with survival in long-term survivors (≥10 years) from brain metastasis (BM). In this study, the records of 1953 patients who underwent treatment for BM with a potential for ≥10 years of follow-up were reviewed. Cox regression analysis identified factors predictive for overall survival (OS). The median age at brain metastasis diagnosis was 60 years and the median OS was 6.4 months. The 1-year OS rate was 29.9, 12.1 % at 2 years, 3.0 % at 5 years, and 1.3 % at 10 years. On multivariable analysis, factors associated with worse OS included gender (males, HR 1.2), multiple brain metastases (HR 1.3), no surgery (HR 1.8), and no stereotactic radiosurgery (HR 1.8) (p < 0.0001 each). Fifty-six patients (2.9 %) survived ≥5 years; 23 patients (1.2 %) survived ≥10 years and the median survival for ≥10 year survivors was 18.5 years. Six of the 10-year survivors had an intracranial recurrence, five occurred within 11 years from the first treatment. Presence of a solitary lesion or single lesion at the time of brain metastasis diagnosis was associated with improved survival. Eight of the ≥10 year survivors (34.8 %) had no neurological symptoms at last follow-up; none of the 10-year survivors were documented to have a neurologic death. Our study demonstrates that patients with favorable prognostic features should undergo multimodality treatment. Albeit rare, patients who are alive 10 years after treatment for their brain metastases may be considered cured from their intracranial disease.

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Acknowledgments

The authors would like to thank Sherry Soeder, CNP for her excellent care of the long-term survivors from brain metastasis during clinical follow-up and her assistance with data collection.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA

    Rupesh Kotecha, John H. Suh, Erin S. Murphy, Chandana A. Reddy & Samuel T. Chao

  2. Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, OH, USA

    Sally Vogel

  3. Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland, OH, 44195, USA

    John H. Suh, Gene H. Barnett, Erin S. Murphy, Michael Parsons, Michael A. Vogelbaum, Lilyana Angelov, Alireza M. Mohammadi, Glen H. J. Stevens, David M. Peereboom, Manmeet S. Ahluwalia & Samuel T. Chao

  4. Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA

    Gene H. Barnett, Michael A. Vogelbaum, Lilyana Angelov & Alireza M. Mohammadi

  5. Center for Behavioral Health, Cleveland Clinic, Cleveland, OH, USA

    Michael Parsons

  6. Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA

    Glen H. J. Stevens

  7. Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA

    David M. Peereboom & Manmeet S. Ahluwalia

Authors
  1. Rupesh Kotecha
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  2. Sally Vogel
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  3. John H. Suh
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  6. Chandana A. Reddy
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  7. Michael Parsons
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  8. Michael A. Vogelbaum
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  9. Lilyana Angelov
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  10. Alireza M. Mohammadi
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  11. Glen H. J. Stevens
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  12. David M. Peereboom
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  13. Manmeet S. Ahluwalia
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  14. Samuel T. Chao
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Corresponding author

Correspondence to Samuel T. Chao.

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Conflict of interest

R. Kotecha: none; S. Vogel: none; J. H. Suh: research support Varian Medical Systems, Travel Elekta; G. H. Barnett: none; E. S. Murphy: none; C. A. Reddy: none; M. Parsons: none; M. A. Vogelbaum: equity and royalty interests, company founder and officer for Infuseon Therapeutics, Inc; Honorarium for scientific advisory meeting from Pharmicokinesis, Inc.; Honorarium for DSMB membership from Neuralstem, Inc.; L. Angelov: none; A. Mohammadi: none; G. Stevens: consulting for Medtronic, Inc.; D. Peereboom: none; M. Ahluwalia: consulting and grant from Elekta; grant support from Boehringer Ingelheim, Bristol-Myers Squibb, Novartis, Spectrum Pharmaceuticals, Tracon Pharmaceuticals, Novocure; consultant for Merck, Genentech/Roche, Incyte, Caris Lifesciences, Monteris Medical, MRI interventions Inc.; S.T. Chao: consulting for Varian Medical Systems.

Electronic supplementary material

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11060_2016_2208_MOESM1_ESM.jpg

Supplemental Fig 1 Kaplan-Meier curves of survival estimates for all patients (A) and ≥10 year survivors (B) from brain metastasis based on the number of lesions at the time of diagnosis (JPG 69 KB)

11060_2016_2208_MOESM2_ESM.jpg

Supplemental Fig 1 Kaplan-Meier curves of survival estimates for all patients (A) and ≥10 year survivors (B) from brain metastasis based on the number of lesions at the time of diagnosis (JPG 36 KB)

11060_2016_2208_MOESM3_ESM.jpg

Supplemental Fig. 2 Freedom-from intracranial relapse (local or distant brain failure) for patients with a minimum for 5 years of survival from brain metastasis diagnosis. (JPG 58 KB)

Supplemental Table 1 Cox proportional hazards models of overall survival for all brain metastases patients (DOCX 19 KB)

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Kotecha, R., Vogel, S., Suh, J.H. et al. A cure is possible: a study of 10-year survivors of brain metastases. J Neurooncol 129, 545–555 (2016). https://doi.org/10.1007/s11060-016-2208-8

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  • DOI: https://doi.org/10.1007/s11060-016-2208-8

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