Whole-Brain Radiotherapy vs. Localized Radiotherapy after Resection of Brain Metastases in the Era of Targeted Therapy: A Retrospective Study
Whether targeted therapy (TT) and radiotherapy impact survival after resection of brain metastases (BM) is unknown. The purpose of this study was to analyze the factors affecting overall survival (OS), local control (LC), distant control (DC), and leptomeningeal metastases (LMM) in patients who had...
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MDPI AG
2021-09-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/13/18/4711 |
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| author | Jaho Koo Tae Hoon Roh Sang Ryul Lee Jaesung Heo Young-Taek Oh Se-Hyuk Kim |
| author_facet | Jaho Koo Tae Hoon Roh Sang Ryul Lee Jaesung Heo Young-Taek Oh Se-Hyuk Kim |
| author_sort | Jaho Koo |
| collection | DOAJ |
| description | Whether targeted therapy (TT) and radiotherapy impact survival after resection of brain metastases (BM) is unknown. The purpose of this study was to analyze the factors affecting overall survival (OS), local control (LC), distant control (DC), and leptomeningeal metastases (LMM) in patients who had undergone resection of BM. We retrospectively analyzed 124 consecutive patients who had undergone resection of BM between 2004 and 2020. Patient information about age, sex, Karnofsky Performance Scale (KPS), origin of cancer, synchronicity, tumor size, status of primary cancer, use of TT, extent of resection, and postoperative radiotherapy was collected. Radiation therapy was categorized into whole-brain radiotherapy (WBRT), localized radiotherapy (local brain radiotherapy or stereotactic radiosurgery (LBRT/SRS)), and no radiation. We identified factors that affect OS, LC, DC, and LMM. In multivariable analysis, significant factors for OS were higher KPS score (≥90) (HR 0.53, <i>p</i> = 0.011), use of TT (HR 0.43, <i>p</i> = 0.001), controlled primary disease (HR 0.63, <i>p</i> = 0.047), and single BM (HR 0.55, <i>p</i> = 0.016). Significant factors for LC were gross total resection (HR 0.29, <i>p</i> = 0.014) and origin of cancer (<i>p</i> = 0.041). Both WBRT and LBRT/SRS showed superior LC than no radiation (HR 0.32, <i>p</i> = 0.034 and HR 0.38, <i>p</i> = 0.018, respectively). Significant factors for DC were use of TT (HR 0.54, <i>p</i> = 0.022) and single BM (HR 0.47, <i>p</i> = 0.004). Reduced incidence of LMM was associated with use of TT (HR 0.42, <i>p</i> = 0.038), synchronicity (HR 0.25, <i>p</i> = 0.028), and controlled primary cancer (HR 0.44, <i>p</i> = 0.047). TT was associated with prolonged OS, improved DC, and reduced LMM in resected BM patients. WBRT and LBRT/SRS showed similar benefits on LC. Considering the extended survival of cancer patients and the long-term effect of WBRT on cognitive function, LBRT/SRS appears to be a good option after resection of BM. |
| first_indexed | 2024-03-10T07:50:51Z |
| format | Article |
| id | doaj.art-fe2b912c7b7b47f6bcf6382914342321 |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T07:50:51Z |
| publishDate | 2021-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-fe2b912c7b7b47f6bcf63829143423212023-11-22T12:19:25ZengMDPI AGCancers2072-66942021-09-011318471110.3390/cancers13184711Whole-Brain Radiotherapy vs. Localized Radiotherapy after Resection of Brain Metastases in the Era of Targeted Therapy: A Retrospective StudyJaho Koo0Tae Hoon Roh1Sang Ryul Lee2Jaesung Heo3Young-Taek Oh4Se-Hyuk Kim5Gamma Knife Center, Brain Tumor Center, Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon 16499, KoreaGamma Knife Center, Brain Tumor Center, Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon 16499, KoreaGamma Knife Center, Brain Tumor Center, Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon 16499, KoreaBrain Tumor Center, Department of Radiation Oncology, Ajou University Hospital, Ajou University School of Medicine, Suwon 16499, KoreaBrain Tumor Center, Department of Radiation Oncology, Ajou University Hospital, Ajou University School of Medicine, Suwon 16499, KoreaGamma Knife Center, Brain Tumor Center, Department of Neurosurgery, Ajou University Hospital, Ajou University School of Medicine, Suwon 16499, KoreaWhether targeted therapy (TT) and radiotherapy impact survival after resection of brain metastases (BM) is unknown. The purpose of this study was to analyze the factors affecting overall survival (OS), local control (LC), distant control (DC), and leptomeningeal metastases (LMM) in patients who had undergone resection of BM. We retrospectively analyzed 124 consecutive patients who had undergone resection of BM between 2004 and 2020. Patient information about age, sex, Karnofsky Performance Scale (KPS), origin of cancer, synchronicity, tumor size, status of primary cancer, use of TT, extent of resection, and postoperative radiotherapy was collected. Radiation therapy was categorized into whole-brain radiotherapy (WBRT), localized radiotherapy (local brain radiotherapy or stereotactic radiosurgery (LBRT/SRS)), and no radiation. We identified factors that affect OS, LC, DC, and LMM. In multivariable analysis, significant factors for OS were higher KPS score (≥90) (HR 0.53, <i>p</i> = 0.011), use of TT (HR 0.43, <i>p</i> = 0.001), controlled primary disease (HR 0.63, <i>p</i> = 0.047), and single BM (HR 0.55, <i>p</i> = 0.016). Significant factors for LC were gross total resection (HR 0.29, <i>p</i> = 0.014) and origin of cancer (<i>p</i> = 0.041). Both WBRT and LBRT/SRS showed superior LC than no radiation (HR 0.32, <i>p</i> = 0.034 and HR 0.38, <i>p</i> = 0.018, respectively). Significant factors for DC were use of TT (HR 0.54, <i>p</i> = 0.022) and single BM (HR 0.47, <i>p</i> = 0.004). Reduced incidence of LMM was associated with use of TT (HR 0.42, <i>p</i> = 0.038), synchronicity (HR 0.25, <i>p</i> = 0.028), and controlled primary cancer (HR 0.44, <i>p</i> = 0.047). TT was associated with prolonged OS, improved DC, and reduced LMM in resected BM patients. WBRT and LBRT/SRS showed similar benefits on LC. Considering the extended survival of cancer patients and the long-term effect of WBRT on cognitive function, LBRT/SRS appears to be a good option after resection of BM.https://www.mdpi.com/2072-6694/13/18/4711brain metastasesradiosurgerytargeted therapysurvivalsurgery |
| spellingShingle | Jaho Koo Tae Hoon Roh Sang Ryul Lee Jaesung Heo Young-Taek Oh Se-Hyuk Kim Whole-Brain Radiotherapy vs. Localized Radiotherapy after Resection of Brain Metastases in the Era of Targeted Therapy: A Retrospective Study Cancers brain metastases radiosurgery targeted therapy survival surgery |
| title | Whole-Brain Radiotherapy vs. Localized Radiotherapy after Resection of Brain Metastases in the Era of Targeted Therapy: A Retrospective Study |
| title_full | Whole-Brain Radiotherapy vs. Localized Radiotherapy after Resection of Brain Metastases in the Era of Targeted Therapy: A Retrospective Study |
| title_fullStr | Whole-Brain Radiotherapy vs. Localized Radiotherapy after Resection of Brain Metastases in the Era of Targeted Therapy: A Retrospective Study |
| title_full_unstemmed | Whole-Brain Radiotherapy vs. Localized Radiotherapy after Resection of Brain Metastases in the Era of Targeted Therapy: A Retrospective Study |
| title_short | Whole-Brain Radiotherapy vs. Localized Radiotherapy after Resection of Brain Metastases in the Era of Targeted Therapy: A Retrospective Study |
| title_sort | whole brain radiotherapy vs localized radiotherapy after resection of brain metastases in the era of targeted therapy a retrospective study |
| topic | brain metastases radiosurgery targeted therapy survival surgery |
| url | https://www.mdpi.com/2072-6694/13/18/4711 |
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