Short-term survivors with brain metastases have modest benefits from focal and systemic therapies and remain frequent despite improving treatment landscape
Purpose: Therapeutic options for patients with brain metastases (BM) increase. While these lead to considerable survival effects in subgroups, there is limited knowledge about characteristics, prognosticators and treatment effects in patients with BM and short survival. Methods: Patients with a surv...
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| Format: | Article |
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Elsevier
2025-03-01
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| Series: | Clinical and Translational Radiation Oncology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405630825000096 |
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| author | M. Czogalla J. Stöhr N. Gleim K. Papsdorf S. Klagges P. Hambsch T. Kuhnt F. Nägler A. Barrantes-Freer J. Wach N.H. Nicolay C. Seidel |
| author_facet | M. Czogalla J. Stöhr N. Gleim K. Papsdorf S. Klagges P. Hambsch T. Kuhnt F. Nägler A. Barrantes-Freer J. Wach N.H. Nicolay C. Seidel |
| author_sort | M. Czogalla |
| collection | DOAJ |
| description | Purpose: Therapeutic options for patients with brain metastases (BM) increase. While these lead to considerable survival effects in subgroups, there is limited knowledge about characteristics, prognosticators and treatment effects in patients with BM and short survival. Methods: Patients with a survival time of ≤ 6 months (short-term survivors, STS), diagnosed with BM between 2009–2021 at a large tertiary cancer center were analysed. Clinical and treatment characteristics, pathological data and causes of death were documented. Descriptive statistics, treatment-specific univariate Kaplan-Meier estimator analyses and multivariate Cox regression were performed. Results: Among 1248 patients with BM, 480 (38 %) were STS. 256 STS with detailed clinical records were included in this analysis. In univariate and multivariate analysis, Karnofsky Performance Status (KPS) (p < 0.001) and number of BM (p = 0.004) were prognostic. In 75 % of patients, the ds-GPA score predicted short-term survival. Use of resection with focal radiotherapy (p < 0.001) and systemic treatment (p < 0.001) appeared prognostically favourable compared to whole brain radiotherapy (WBRT) alone. However, survival benefits were very modest, with a median gain of 6 weeks following resection and focal radiotherapy compared to whole-brain radiotherapy, and 3 weeks from systemic treatment. Systemic tumor progression was documented as the cause of death in the majority of patients. Over the examined time period, the ratio between STS and other patients remained without significant change. Conclusion: Within STS, KPS and number of BM are of prognostic relevance. There is benefit from local and systemic therapy to a limited extent. Shared and carefully discussed individual therapy decisions are necessary. |
| format | Article |
| id | doaj-art-56375379da5c418683175a2b226cb366 |
| institution | Kabale University |
| issn | 2405-6308 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical and Translational Radiation Oncology |
| spelling | doaj-art-56375379da5c418683175a2b226cb3662025-01-30T05:14:31ZengElsevierClinical and Translational Radiation Oncology2405-63082025-03-0151100919Short-term survivors with brain metastases have modest benefits from focal and systemic therapies and remain frequent despite improving treatment landscapeM. Czogalla0J. Stöhr1N. Gleim2K. Papsdorf3S. Klagges4P. Hambsch5T. Kuhnt6F. Nägler7A. Barrantes-Freer8J. Wach9N.H. Nicolay10C. Seidel11Department of Radiation Oncology, University of Leipzig Medical Center, Stephanstraße 9a, 04103 Leipzig, Germany; Comprehensive Cancer Center Central Germany, Partner Site Leipzig, Liebigstraße 22, 04103 Leipzig, GermanyDepartment of Radiation Oncology, University of Leipzig Medical Center, Stephanstraße 9a, 04103 Leipzig, Germany; Comprehensive Cancer Center Central Germany, Partner Site Leipzig, Liebigstraße 22, 04103 Leipzig, GermanyDepartment of Radiation Oncology, University of Leipzig Medical Center, Stephanstraße 9a, 04103 Leipzig, Germany; Comprehensive Cancer Center Central Germany, Partner Site Leipzig, Liebigstraße 22, 04103 Leipzig, GermanyDepartment of Radiation Oncology, University of Leipzig Medical Center, Stephanstraße 9a, 04103 Leipzig, Germany; Comprehensive Cancer Center Central Germany, Partner Site Leipzig, Liebigstraße 22, 04103 Leipzig, GermanyClinical Cancer Registry Leipzig, Philipp-Rosenthal-Straße 27b, 04103 Leipzig, GermanyDepartment of Radiation Oncology, University of Leipzig Medical Center, Stephanstraße 9a, 04103 Leipzig, Germany; Comprehensive Cancer Center Central Germany, Partner Site Leipzig, Liebigstraße 22, 04103 Leipzig, GermanyDepartment of Radiation Oncology, University of Leipzig Medical Center, Stephanstraße 9a, 04103 Leipzig, Germany; Comprehensive Cancer Center Central Germany, Partner Site Leipzig, Liebigstraße 22, 04103 Leipzig, GermanyDepartment of Radiation Oncology, University of Leipzig Medical Center, Stephanstraße 9a, 04103 Leipzig, Germany; Comprehensive Cancer Center Central Germany, Partner Site Leipzig, Liebigstraße 22, 04103 Leipzig, GermanyDepartment of Neuropathology,University of Leipzig Medical Center, Liebigstraße 26, 04103 Leipzig, GermanyDepartment of Neurosurgery, University of Leipzig Medical Center, Liebigstraße 20, 04103 Leipzig, Germany; Comprehensive Cancer Center Central Germany, Partner Site Leipzig, Liebigstraße 22, 04103 Leipzig, GermanyDepartment of Radiation Oncology, University of Leipzig Medical Center, Stephanstraße 9a, 04103 Leipzig, Germany; Comprehensive Cancer Center Central Germany, Partner Site Leipzig, Liebigstraße 22, 04103 Leipzig, GermanyDepartment of Radiation Oncology, University of Leipzig Medical Center, Stephanstraße 9a, 04103 Leipzig, Germany; Comprehensive Cancer Center Central Germany, Partner Site Leipzig, Liebigstraße 22, 04103 Leipzig, Germany; Corresponding author at: Department of Radiation Oncology, University of Leipzig Medical Center, Stephanstraße 9a, 04103 Leipzig, Germany.Purpose: Therapeutic options for patients with brain metastases (BM) increase. While these lead to considerable survival effects in subgroups, there is limited knowledge about characteristics, prognosticators and treatment effects in patients with BM and short survival. Methods: Patients with a survival time of ≤ 6 months (short-term survivors, STS), diagnosed with BM between 2009–2021 at a large tertiary cancer center were analysed. Clinical and treatment characteristics, pathological data and causes of death were documented. Descriptive statistics, treatment-specific univariate Kaplan-Meier estimator analyses and multivariate Cox regression were performed. Results: Among 1248 patients with BM, 480 (38 %) were STS. 256 STS with detailed clinical records were included in this analysis. In univariate and multivariate analysis, Karnofsky Performance Status (KPS) (p < 0.001) and number of BM (p = 0.004) were prognostic. In 75 % of patients, the ds-GPA score predicted short-term survival. Use of resection with focal radiotherapy (p < 0.001) and systemic treatment (p < 0.001) appeared prognostically favourable compared to whole brain radiotherapy (WBRT) alone. However, survival benefits were very modest, with a median gain of 6 weeks following resection and focal radiotherapy compared to whole-brain radiotherapy, and 3 weeks from systemic treatment. Systemic tumor progression was documented as the cause of death in the majority of patients. Over the examined time period, the ratio between STS and other patients remained without significant change. Conclusion: Within STS, KPS and number of BM are of prognostic relevance. There is benefit from local and systemic therapy to a limited extent. Shared and carefully discussed individual therapy decisions are necessary.http://www.sciencedirect.com/science/article/pii/S2405630825000096Short-term survivorsBrain metastasesRadiotherapySystemic therapy |
| spellingShingle | M. Czogalla J. Stöhr N. Gleim K. Papsdorf S. Klagges P. Hambsch T. Kuhnt F. Nägler A. Barrantes-Freer J. Wach N.H. Nicolay C. Seidel Short-term survivors with brain metastases have modest benefits from focal and systemic therapies and remain frequent despite improving treatment landscape Clinical and Translational Radiation Oncology Short-term survivors Brain metastases Radiotherapy Systemic therapy |
| title | Short-term survivors with brain metastases have modest benefits from focal and systemic therapies and remain frequent despite improving treatment landscape |
| title_full | Short-term survivors with brain metastases have modest benefits from focal and systemic therapies and remain frequent despite improving treatment landscape |
| title_fullStr | Short-term survivors with brain metastases have modest benefits from focal and systemic therapies and remain frequent despite improving treatment landscape |
| title_full_unstemmed | Short-term survivors with brain metastases have modest benefits from focal and systemic therapies and remain frequent despite improving treatment landscape |
| title_short | Short-term survivors with brain metastases have modest benefits from focal and systemic therapies and remain frequent despite improving treatment landscape |
| title_sort | short term survivors with brain metastases have modest benefits from focal and systemic therapies and remain frequent despite improving treatment landscape |
| topic | Short-term survivors Brain metastases Radiotherapy Systemic therapy |
| url | http://www.sciencedirect.com/science/article/pii/S2405630825000096 |
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