Re-irradiation in patients with progressive or recurrent brain metastases from extracranial solid tumors: A novel prognostic index

Autores organización

• 

  Andres Felipe Cardona Mendoza

  Autor

Autores

• Gutierrez Torres S
• Maldonado Magos F
• Turcott JG
• Hernandez-Martinez J.-M.
• Cacho-Díaz B
• Mota-García A
• Lozano Ruiz F
• Ramos-Ramirez M
• Arrieta O

Grupos de investigación

• Grupo de Inmunología celular y molecular Universidad El Bosque (InmuBo)

  Investigador

  Maria Consuelo Romero Sanchez

Resumen

Background: Most studies evaluating factors associated with the survival of patients with brain metastases (BM) have focused on patients with newly diagnosed BM. This study aimed to identify prognostic factors associated with survival after brain re-irradiation in order to develop a new prognostic index. Methods: This 5-year retrospective study included patients treated with repeat-radiotherapy for recurrent BM at the “Instituto Nacional de Cancerología” of Mexico between 2015 and 2019. Significant variables in the multivariate Cox regression analysis were used to create the brain re-irradiation index (BRI). Survival and group comparisons were performed using the Kaplan–Meier method and the log-rank test. Results: Fifty-seven patients receiving brain re-irradiation were identified. Most patients were women (75.4%) with a mean age at BM diagnosis of 51.4 years. Lung and breast cancer were the most prevalent neoplasms (43.9% each). Independent prognostic factors for shorter survival after re-irradiation were: Age >50 years (hazard ratio [HR]:2.5 [95% confidence interval [CI], 1.1–5.8]; p = 0.026), uncontrolled primary tumor (HR:5.5 [95% CI, 2.2–13.5]; p < 0.001), lesion size >20 mm (4.6 [95% CI, 1.7–12.2]; p = 0.002), and an interval <12 months between radiation treatments (HR:4.3 [95% CI, 1.7–10.6]; p = 0.001). Median survival (MS) after re-irradiation was 14.6 months (95% CI, 8.2–20.9).MS of patients stratified according to the BRI score was 17.38, 10.34, and 2.82 months, with significant differences between all groups. Conclusions: The new BRI can be easily implemented for the prognostic classification of cancer patients with progressive or recurrent BM from extracranial solid tumors. © 2022 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

© 2022 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Keywords

• Brain Neoplasms; Female; Humans; Male; Middle Aged; Prognosis; Proportional Hazards Models; Re-Irradiation; Retrospective Studies; anaplastic lymphoma kinase; epidermal growth factor receptor; Ki 67 antigen; adult; alveolar soft part sarcoma; Article; brain metastasis; breast cancer; cancer prognosis; cancer radiotherapy; cancer recurrence; cancer survival; cohort analysis; ECOG Performance Status; female; follow up; headache; histology; human; human tissue; irradiation; Kaplan Meier method; log rank test; lung cancer; major clinical study; male; melanoma; metastasis; nausea; nuclear magnetic resonance imaging; ovary carcinoma; re-irradiation; retrospective study; seizure; solid malignant neoplasm; solid tumor; uterine carcinosarcoma; vertigo; whole brain radiotherapy; brain tumor; middle aged; pathology; prognosis; proportional hazards model