Whole brain radiotherapy for the treatment of newly diagnosed multiple brain metastases.
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ABSTRACT:
SUBMITTER: Tsao MN
PROVIDER: S-EPMC6491334 | biostudies-literature | 2018 Jan
REPOSITORIES: biostudies-literature
Publications
Whole brain radiotherapy for the treatment of newly diagnosed multiple brain metastases.
Tsao May N MN Xu Wei W Wong Rebecca Ks RK Lloyd Nancy N Laperriere Normand N Sahgal Arjun A Rakovitch Eileen E Chow Edward E
The Cochrane database of systematic reviews 20180125
<h4>Background</h4>This is an update to the review published in the Cochrane Library (2012, Issue 4).It is estimated that 20% to 40% of people with cancer will develop brain metastases during the course of their illness. The burden of brain metastases impacts quality and length of survival.<h4>Objectives</h4>To assess the effectiveness and adverse effects of whole brain radiotherapy (WBRT) given alone or in combination with other therapies to adults with newly diagnosed multiple brain metastases ...[more]
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Project description:Median survival of non-small cell lung cancer (NSCLC) patients with brain metastases is poor. We examined concurrent erlotinib and whole brain radiotherapy (WBRT) followed by maintenance erlotinib in patients with untreated brain metastases, given the potential radiosensitizing properties of erlotinib and its direct effect on brain metastases and systemic activity. Eighty NSCLC patients with KPS of 70 and greater and multiple brain metastases were randomly assigned to placebo (n = 40) or erlotinib (100mg, n = 40) given concurrently with WBRT (20 Gy in 5 fractions). Following WBRT, patients continued with placebo or erlotinib (150 mg) until disease progression. The primary end point was neurological progression-free survival (nPFS); hazard ratios (HRs) were calculated using Cox regression. All P values were two-sided. Fifteen patients (37.5%) from each arm were alive and without neurological progression 2 months after WBRT. Median nPFS was 1.6 months in both arms; nPFS HR 0.95 (95% CI = 0.59 to 1.54; P = .84). Median overall survival (OS) was 2.9 and 3.4 months in the placebo and erlotinib arms; HR 0.95 (95% CI = 0.58 to 1.55; P = .83). The frequency of epidermal growth factor receptor (EGFR) mutations was low with only 1 of 35 (2.9%) patients with available samples had activating EGFR-mutations. Grade 3/4 adverse event rates were similar between the two groups (70.0% in each arm), except for rash 20.0% (erlotinib) vs 5.0% (placebo), and fatigue 17.5% vs 35.0%. No statistically significant quality of life differences were found. Our study showed no advantage in nPFS or OS for concurrent erlotinib and WBRT followed by maintenance erlotinib in patients with predominantly EGFR wild-type NSCLC and multiple brain metastases compared to placebo. Future studies should focus on the role of erlotinib with or without WBRT in patients with EGFR mutations.
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Project description:BackgroundThe landscape of brain metastases radiotherapy is evolving, with a shift away from whole-brain radiotherapy (WBRT) toward targeted stereotactic approaches aimed at preserving neurocognitive functions and maintaining overall quality of life. For patients with multiple metastases, especially in cases where targeted radiotherapy is no longer feasible due to widespread dissemination, the concept of hippocampal sparing radiotherapy (HA_WBRT) gains prominence.MethodsIn this narrative review we explore the role of the hippocampi in memory formation and the implications of their postradiotherapy lateral damage. We also consider the potential advantages of selectively sparing one hippocampus during whole-brain radiotherapy (WBRT). Additionally, by systematic evaluation of relevant papers published on PubMed database over last 20 years, we provide a comprehensive overview of the various changes that can occur in the left or right hippocampus as a consequence of radiotherapy.ResultsWhile it is important to note that various neurocognitive functions are interconnected throughout the brain, we can discern certain specialized roles of the hippocampi. The left hippocampus appears to play a predominant role in verbal memory, whereas the right hippocampus is associated more with visuospatial memory. Additionally, the anterior part of the hippocampus is more involved in episodic memory and emotional processing, while the posterior part is primarily responsible for spatial memory and pattern separation. Notably, a substantial body of evidence demonstrates a significant correlation between post-radiotherapy changes in the left hippocampus and subsequent cognitive decline in patients.ConclusionIn the context of individualized palliative radiotherapy, sparing the unilateral (specifically, the left, which is dominant in most individuals) hippocampus could expand the repertoire of strategies available for adapted WBRT in cases involving multiple brain metastases where stereotactic radiotherapy is not a viable option. Prospective ongoing studies assessing various memory-sparing radiotherapy techniques will define new standard of radiotherapy care of patients with multiple brain metastases.
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Project description:IntroductionWhole-brain radiotherapy simultaneous integrated boost intensity-modulated radiotherapy (WBRT + SIB-IMRT) is a potential treatment approach for brain metastasis (BM) that may result in improved overall survival (OS). However, the safety and efficacy of WBRT + SIB-IMRT combined with anlotinib for BM treatment remain uncertain.MethodsWe retrospectively compared the safety and efficacy of anlotinib + WBRT + SIB-IMRT with those of WBRT + SIB-IMRT in patients with BM from 2019 to 2022. The adverse reaction type and grade, intracranial objective response rate (iORR), intracranial disease control rate (iDCR), OS, and intracranial progression-free survival (iPFS) of anlotinib + WBRT + SIB-IMRT were compared with those of WBRT + SIB-IMRT alone.ResultsIn total, 63 patients received either anlotinib + WBRT + SIB-IMRT or WBRT + SIB-IMRT alone (n = 31 and 32, respectively). No significant clinical differences were found between the two groups. The iORR and iDCR were higher in the anlotinib + WBRT + SIB-IMRT group than in the WBRT + SIB-IMRT group. The median iPFS and median OS of the 31 patients who received anlotinib + WBRT + SIB-IMRT were 14.5 and 18.9 months, respectively, whereas the median iPFS and median OS for the 32 patients who received WBRT + SIB-IMRT alone were 11.4 and 14.9 months, respectively. Thus, anlotinib combined with WBRT + SIB-IMRT increased the duration of iPFS, but not OS. iPFS was influenced by the Karnofsky Performance Status (KPS) score, age, extracranial distant metastasis, and addition of anlotinib to treatment, whereas OS correlated with age, extracranial distant metastasis, and KPS score. No treatment-related adverse events of grade 3 or higher occurred in either group.ConclusionsAnlotinib combined with WBRT + SIB-IMRT is effective for BM and is well tolerated by patients.
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Project description: Not available
| S-EPMC11543091 | biostudies-literature
Project description:PurposeThis study aimed to evaluate the survival outcomes of whole brain radiotherapy (WBRT) compared to whole brain radiotherapy plus local radiation boost (WBRT + boost), and further identify whether higher biologically effective dose (BED) of WBRT + boost translates into a survival benefit in small cell lung cancer (SCLC) patients with brain metastasis (BM).MethodsSCLC patients with BM from January 1, 2012, to December 31, 2019, were retrospectively analyzed. Overall survival (OS) and intracranial progression-free survival (iPFS) were evaluated by the Kaplan-Meier method and compared by the log-rank test. Univariate and multivariate regression analyses of prognostic factors for OS were performed using Cox proportional hazards regression models. The cutoff value of BED was determined by the receiver operating characteristic (ROC) curve analysis.ResultsAmong the 180 eligible patients, 82 received WBRT + boost and 98 received WBRT. Both OS and iPFS in the WBRT + boost group were significantly superior to those in the WBRT group (median OS: 20 vs. 14 months, p = 0.011; median iPFS: 16 vs. 10 months, p = 0.003). At a cutoff value of 58.35 Gy in the WBRT + boost group, 52 for the high-BED (>58.35 Gy) group, 30 for the low-BED (≤58.35 Gy) group. High BED was significantly associated with improved OS and iPFS compared with low BED in the WBRT + boost group (median OS: 23 vs. 17 months, p = 0.002; median iPFS: 17 vs. 10 months, p = 0.002).ConclusionsCompared with WBRT alone, WBRT + boost improved OS and iPFS in SCLC patients with BM. High BED (>58.35 Gy) for WBRT + boost may be a reasonable consideration for SCLC patients with BM.
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