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25.07.2016 | Clinical Study | Ausgabe 3/2016

Journal of Neuro-Oncology 3/2016

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

Zeitschrift:
Journal of Neuro-Oncology > Ausgabe 3/2016
Autoren:
Rupesh Kotecha, Sally Vogel, John H. Suh, Gene H. Barnett, Erin S. Murphy, Chandana A. Reddy, Michael Parsons, Michael A. Vogelbaum, Lilyana Angelov, Alireza M. Mohammadi, Glen H. J. Stevens, David M. Peereboom, Manmeet S. Ahluwalia, Samuel T. Chao
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1007/​s11060-016-2208-8) contains supplementary material, which is available to authorized users.
Presented in part at the ASTRO 57th Annual Meeting in San Antonio, TX from October 18–21, 2015.

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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Zusatzmaterial
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_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 36 KB)
11060_2016_2208_MOESM2_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)
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Supplemental Table 1 Cox proportional hazards models of overall survival for all brain metastases patients (DOCX 19 KB)
11060_2016_2208_MOESM4_ESM.docx
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