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. 2024 Apr;200(4):335-345.
doi: 10.1007/s00066-023-02123-4. Epub 2023 Aug 30.

Long-term survival in patients with brain metastases-clinical characterization of a rare scenario

M Hügel  1 , J Stöhr  1 , T Kuhnt  1 , F Nägler  1 , K Papsdorf  1 , S Klagges  2 , P Hambsch  1 , E Güresir  3 , N H Nicolay  1 , C Seidel  4
Affiliations

Long-term survival in patients with brain metastases-clinical characterization of a rare scenario

M Hügel et al. Strahlenther Onkol. 2024 Apr.

Abstract

Purpose: This study aimed to assess clinical, treatment, and prognostic features in patients with brain metastases (BM) from solid tumors achieving long-term survival (LTS). Further, the accuracy of diagnosis-specific Graded Prognostic Assessment scores (ds-GPA) to predict LTS was evaluated.

Methods: Patients admitted for radiotherapy of BM between 2010 and 2020 at a large tertiary cancer center with survival of at least 3 years from diagnosis of BM were included. Patient, tumor, treatment characteristics and ds-GPA were compiled retrospectively.

Results: From a total of 1248 patients with BM, 61 (4.9%) survived ≥ 3 years. In 40 patients, detailed patient charts were available. Among LTS patients, median survival time from diagnosis of BM was 51.5 months. Most frequent primary tumors were lung cancer (45%), melanoma (20%), and breast cancer (17.5%). At the time of diagnosis of BM, 11/40 patients (27.5%) had oligometastatic disease. Estimated mean survival time based on ds-GPA was 19.7 months (in 8 cases estimated survival < 12 months). Resection followed by focal or whole-brain radiotherapy (WBRT) was often applied (60%), followed by primary stereotactic radiotherapy (SRT) (20%) or WBRT (20%). 80% of patients received systemic treatment, appearing particularly active in specifically altered non-small lung cancer (NSCLC), melanoma, and HER2-positive breast cancer. Karnofsky performance score (KPS) and the presence of oligometastatic disease at BM diagnosis were persisting prognostic factors in LTS patients.

Conclusion: In this monocentric setting reflecting daily pattern of care, LTS with BM is heterogeneous and difficult to predict. Effective local treatment and modern systemic therapies often appear crucial for LTS. The impact of concomitant diseases and frailty is not clear.

Keywords: Frailty; Stereotactic radiotherapy; Systemic therapy; Whole brain radiotherapy; ds-GPA.

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Conflict of interest statement

N. H. Nicolay has received research grants from Novocure and speaker honoraria from Merck. C. Seidel has received speaker and/or advisory board honoraria from AbbVie, Bristol-Myers Squibb, HRA Pharma, Medac, Novocure, Roche, Seagen. M. Hügel, J. Stöhr, T. Kuhnt, F. Nägler, K. Papsdorf, S. Klagges, P. Hambsch and E. Güresir declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Survival in months after diagnosis of brain metastases
Fig. 2
Fig. 2
Survival among long-term survival patients depending on primary tumor (a), patient age (b), and KPS (c)
Fig. 3
Fig. 3
Survival among long-term survival patients depending on number (a) and timing of brain metastasis (b) and oligometastasis (c)
See this image and copyright information in PMC

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