Multimodality treatment of brain metastases: an institutional survival analysis of 275 patients
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RESEARCH
WORLD JOURNAL OF SURGICAL ONCOLOGY
Open Access
Multimodality treatment of brain metastases: an institutional survival analysis of 275 patients Ameer L Elaimy1,2, Alexander R Mackay1,3, Wayne T Lamoreaux1,2, Robert K Fairbanks1,2, John J Demakas1,4, Barton S Cooke1, Benjamin J Peressini5, John T Holbrook2 and Christopher M Lee1,2*
Abstract Background: Whole brain radiation therapy (WBRT), surgical resection, stereotactic radiosurgery (SRS), and combinations of the three modalities are used in the management of patients with metastatic brain tumors. We present the previously unreported survival outcomes of 275 patients treated for newly diagnosed brain metastases at Cancer Care Northwest and Gamma Knife of Spokane between 1998 and 2008. Methods: The effects treatment regimen, age, Eastern Cooperative Oncology Group-Performance Status (ECOG-PS), primary tumor histology, number of brain metastases, and total volume of brain metastases have on patient overall survival were analyzed. Statistical analysis was performed using Kaplan-Meier survival curves, Andersen 95% confidence intervals, approximate confidence intervals for log hazard-ratios, and multivariate Cox proportional hazard models. Results: The median clinical follow up time was 7.2 months. On multivariate analysis, survival statistically favored patients treated with SRS alone when compared to patients treated with WBRT alone (p < 0.001), patients treated with resection with SRS when compared to patients treated with SRS alone (p = 0.020), patients in ECOG-PS class 0 when compared to patients in ECOG-PS classes 2 (p = 0.04), 3 (p < 0.001), and 4 (p < 0.001), patients in the nonsmall-cell lung cancer group when compared to patients in the combined melanoma and renal-cell carcinoma group (p < 0.001), and patients with breast cancer when compared to patients with non-small-cell lung cancer (p < 0.001). Conclusions: In our analysis, patients benefited from a combined modality treatment approach and physicians must consider patient age, performance status, and primary tumor histology when recommending specific treatments regimens. Keywords: Brain metastases, Survival, Treatment regimen, Age, Performance status, Primary tumor histology, Tumor number, Tumor volume
Background Brain metastases are defined as cancerous lesions in the brain that originate and spread from an extracranial primary cancer. Brain metastases occur in 20 to 40% of patients with systemic cancer and the incidence is growing due to advances in imaging technologies and the treatment of extracranial disease [1]. The site of metastasis often depends on the nearest location of vascular clusters. As a consequence, the most common primary * Correspondence: [email protected] 1 Gamma Knife of Spokane, 910 W 5th Ave, Suite 102, Spokane, WA 99204, USA Full list of author information is available at the end of the article
cancers that have the ability to metastasize to the brain are cancers that develop from the lung or breast [2]. However, metastasis to the brain originating from melanoma, colorect
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