Properly selected patients with multiple brain metastases may benefit from aggressive treatment of their intracranial disease

B. E. Pollock, Paul D. Brown, Robert L. Foote, Scot L. Stafford, Paula J. Schomberg

Research output: Contribution to journalArticle

80 Citations (Scopus)

Abstract

To determine whether properly selected patients with multiple brain metastases benefit from aggressive treatment of their intracranial disease, we reviewed 52 patients having stereotactic radiosurgery (SRS), tumor resection, or both between April 1997 and March 2000. Tumor histology included lung (n = 18,35%), breast (n = 11,21%), renal (n = 6,12%), melanoma (n = 6,12%), and other (n = 11,21%). THe median patient age was 58 years, the median Karnofsky performance status (KPS) was 90, and the median number of tumors was three. Twenty patients (39%) had progressed after prior radiation therapy. Treatment included multiple craniotomies and tumor resection (n = 5,10%), radiosurgery (n = 31,60%), or resection and radiosurgery (n = 16,30%). Median survival was 15.5 months. The one- and two-year actuarial survivals were 63% and 27%, respectively. Multivariate analysis found radiation therapy oncology group recursive partitioning analysis (RTOG RPA) Class (1 vs. 2/3) correlated with improved survival (Relative risk = 2.60, 95% CI 1.13-5.97, p = 0.03) Class 1 patients (KPS ≥ 70, age < 65 years, and controlled primary with no extracranial metastases) survived a median of 19 months whereas Class 3 patients (KPS < 70) survived 8 months. Class 2 patients (all other patients) survived a median of 13 months. Thirty-five patients (67%) had intracranial progression at a median of 8.0 months. Intracranial progression was local (n = 6), distant (n = 23), or local and distant (n = 6); 26 patients with intracranial progression underwent additional brain tumor treatments. Multivariate analysis found patients with radiosensitive tumors (lung, breast, other) had fewer intracranial recurrences compared to patients with radio-resistant tumors (melanoma, renal, sarcoma) (Relative risk = 2.93, 95% CI 1.13-5.10, p = 0.02). The length of survival in our series is quite comparable to historical reports on the management of brain metastasis patients, and supports aggressive intervention for RTOG RPA Class 1 patients and Class 2 patients with controlled primary disease who have a limited number of brain metastases.

Original languageEnglish (US)
Pages (from-to)73-80
Number of pages8
JournalJournal of Neuro-Oncology
Volume61
Issue number1
DOIs
StatePublished - Jan 2003

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Neoplasm Metastasis
Brain
Therapeutics
Karnofsky Performance Status
Radiosurgery
Radiation Oncology
Radiotherapy
Survival
Neoplasms
Melanoma
Multivariate Analysis
Kidney
Lung
Craniotomy
Radio
Brain Neoplasms
Sarcoma
Histology
Breast
Breast Neoplasms

Keywords

  • Brain tumor
  • Metastasis
  • Radiosurgery
  • Surgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Cancer Research
  • Oncology
  • Neuroscience(all)

Cite this

Properly selected patients with multiple brain metastases may benefit from aggressive treatment of their intracranial disease. / Pollock, B. E.; Brown, Paul D.; Foote, Robert L.; Stafford, Scot L.; Schomberg, Paula J.

In: Journal of Neuro-Oncology, Vol. 61, No. 1, 01.2003, p. 73-80.

Research output: Contribution to journalArticle

Pollock, B. E. ; Brown, Paul D. ; Foote, Robert L. ; Stafford, Scot L. ; Schomberg, Paula J. / Properly selected patients with multiple brain metastases may benefit from aggressive treatment of their intracranial disease. In: Journal of Neuro-Oncology. 2003 ; Vol. 61, No. 1. pp. 73-80.
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