Long-Term Survival after Linac-Based Stereotactic Radiosurgery and Radiotherapy with a Micro-Multileaf Collimator for Brain Metastasis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patient Characteristics
2.2. SRS and fSRT
2.3. Clinical and Radiological Follow-Up
2.4. Statistics
3. Results
3.1. Patient Characteristics in Both Groups
3.2. Treatment Outcomes
3.3. Factors Associated with Survival
4. Discussion
4.1. Long-Term Survival after SRT/fSRT for BM
4.2. Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristic | Number | Median Survival Time (Months) | Log-Rank Test |
---|---|---|---|
Sex | |||
Male 140 | 10 | 0.045 | |
Female 86 | 17.5 | ||
Age(years) | |||
Median (range) 68.6 ± 10.3 | age ≥ 70 12.0 | 0.126 | |
age < 70 13.5 | |||
Pretreatment KPS | |||
Median (range) 90 (40–100) | KPS ≥ 80 17.0 | <0.0001 | |
<80 5.5 | |||
Tumor origin | |||
lung/breast/colon/stomach/kidney/esophagus/others | 189/11/9/4/3/3/7 | lung 15.0 | <0.0001 |
non- long 5.0 | |||
Tumor number | |||
single 131 | single 16.0 | 0.173 | |
multiple 95 | multiple 10.0 | ||
Control of primary tumor | |||
yes 93 | yes 21.0 | <0.0001 | |
no 133 | no 8.0 | ||
Extracranial metastasis | |||
yes 99 | yes 7.0 | <0.0001 | |
no 127 | no 19.0 | ||
RPA class | |||
I 13 | I 29.0 | <0.0001 | |
II 160 | II 16.0 | ||
III 53 | III 5.0 |
Characteristic | Survival <24 Months | Survival ≥24 Months | p-Value |
---|---|---|---|
n = 154 | n = 72 | ||
Sex | |||
Female | 51 | 35 | 0.028 |
Male | 103 | 37 | |
Age(years) | 0.338 | ||
69.0 ± 10.5 | 67.6 ± 9.6 | ||
Pretreatment KPS | 0.002 | ||
Median(range) | 80 (50–100) | 100 (50–100) | |
Tumor origin | 0.002 | ||
lung | 121 | 68 | (lung vs. non-lung) |
breast | 10 | 1 | |
colon | 8 | 1 | |
stomach | 4 | 0 | |
kidney | 1 | 2 | |
esophagus | 3 | 0 | |
other | 7 | 0 | |
Mutation status in lung cancer | 0.048 | ||
EGFR positive | 28 | 21 | |
ALK positive | 3 | 7 | |
EGFR/ALK negative | 52 | 26 | |
NA | 38 | 14 | |
Treatment | 0.695 | ||
SRS | 59 | 37 | |
SRS and SRT | 42 | 13 | |
SRT | 53 | 22 | |
Tumor number | 0.248 | ||
median/average/range | 2.16/1/1–9 | 2.08/1/1–9 | |
single | 85 | 46 | |
multiple | 69 | 26 | |
Tumor volume (cc) | 0.881 | ||
median/average/range | 0.3/2.13/0.01–26.52 | 0.31/1.76/0.02–33.51 | |
Control of primary tumor | 0.001 | ||
yes | 52 | 41 | |
no | 102 | 31 | |
Extracranial metastasis | <0.001 | ||
yes | 79 | 20 | |
no | 75 | 52 | |
RPA class | <0.001 | ||
I | 5 | 8 | |
II | 105 | 55 | |
III | 44 | 9 |
Factor | Odds Ratio | 95%CI | p-Value |
---|---|---|---|
Sex (female:vs. male) | 1.94 | 1.050–3.60 | 0.0345 |
Age | 1.02 | 0.989–1.05 | 0.226 |
Number of metastasis | 1.1 | 0.575–2.09 | 0.782 |
Pretreatment KPS | 2.54 | 1.150–5.59 | 0.021 |
Control of primary cancer | 0.638 | 0.332–1.22 | 0.176 |
Extracranial metastasis | 1.56 | 0.67–3.62 | 0.019 |
HR:hazard ratio | |||
CI:confidence interval |
Author (Year) | Modality | Number of Pt | LTS | OS (Range) | Factors in LTS | Cause of Death | Complication |
---|---|---|---|---|---|---|---|
Kondziolka (2005) [6] | GK | 44 /681 pts (6.5%) | ≥4 years | 68 months (48–156 months) | Higher pre-KPS Fewer brain metastases Less extracranial disease | 1 pt: brain 27 pts: systemic cancer | 4 pts (9%): permanent neurological deficits 6 pts (13.6%): salvage surgery |
Yamamoto (2013) [9] | GK | 167 pts (8.4%) | ≥3 years | 49.9 (36–142 months) | NA | 16 pts: brain 76 pts: systemic disease | 17 pts (10.1%): all complications 13 pts (7.8%): salvage surgery |
Cohen-Inbar (2016) [10] | GK | 92 pts | ≥2 years | Survival rate 3 years: 73.7% 4 years: 51.8% 5 years: 41.7% | NA | NA | 7 pts (7.6%): salvage surgery |
Gogineni (2018) [8] | CK (86%) Others (14%) | 132 pts (11.8%) | ≥2 years | NA | NA | NA | NA |
Siddiqui (2020) [7] | GK | 198 pts | ≥ 1 years | 25.2 months (22.9–28.4 months) 2years: 52.8% 3 years: 33.4% 4 years: 22.1% 5 years: 16.6% | NA | NA | 10 pts (5.1%): salvage surgery for radiation necrosis |
This study (2022) | Linac based | 72 pts (31.8%) | ≥2 years | 43 months (36–73) 3 years: 59.1% 4 years: 49.6% 5 years: 40.7% | Female High pre-KPS no extracranial metastasis | 1 pt: brain 43 pts: systemic cancer | 13 pts (18.0%): salvage surgery for 7 recurrences, 5 radiation necrosis, and 1 cyst formation |
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Matsuda, R.; Hasegawa, M.; Tamamoto, T.; Inooka, N.; Nikimoto, M.; Ochi, T.; Miyasaka, T.; Hontsu, S.; Yamaki, K.; Miura, S.; et al. Long-Term Survival after Linac-Based Stereotactic Radiosurgery and Radiotherapy with a Micro-Multileaf Collimator for Brain Metastasis. Curr. Oncol. 2022, 29, 6068-6076. https://doi.org/10.3390/curroncol29090477
Matsuda R, Hasegawa M, Tamamoto T, Inooka N, Nikimoto M, Ochi T, Miyasaka T, Hontsu S, Yamaki K, Miura S, et al. Long-Term Survival after Linac-Based Stereotactic Radiosurgery and Radiotherapy with a Micro-Multileaf Collimator for Brain Metastasis. Current Oncology. 2022; 29(9):6068-6076. https://doi.org/10.3390/curroncol29090477
Chicago/Turabian StyleMatsuda, Ryosuke, Masatoshi Hasegawa, Tetsuro Tamamoto, Nobuyoshi Inooka, Mei Nikimoto, Tomoko Ochi, Toshiteru Miyasaka, Shigeto Hontsu, Kaori Yamaki, Sachiko Miura, and et al. 2022. "Long-Term Survival after Linac-Based Stereotactic Radiosurgery and Radiotherapy with a Micro-Multileaf Collimator for Brain Metastasis" Current Oncology 29, no. 9: 6068-6076. https://doi.org/10.3390/curroncol29090477