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Published in: Journal of Neuro-Oncology 3/2018

01-12-2018 | Clinical Study

Clinical factors associated with mortality within three months after radiosurgery of asymptomatic brain metastases from non-small cell lung cancer

Authors: Bina Kakusa, Summer Han, Sonya Aggarwal, Boxiang Liu, Gordon Li, Scott Soltys, Melanie Hayden Gephart

Published in: Journal of Neuro-Oncology | Issue 3/2018

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Abstract

Purpose

Routine brain MRI surveillance frequently diagnoses small, asymptomatic brain metastases from non-small cell lung cancer (NSCLC) that are effectively treated with stereotactic radiosurgery (SRS). A subset of patients, however, may die prior to the onset of symptoms. This study identifies clinical features that distinguish neurologically-asymptomatic NSCLC brain metastases patients that die prior to routine 3 month follow-up after SRS.

Methods

Retrospective chart review from 2007 to 2017 identified 18 patients with neurologically-asymptomatic NSCLC brain metastases who died < 3 months after SRS. Twenty-eight additional patients meeting criteria and surviving > 6 months after SRS were identified. Clinical factors were examined to determine characteristics correlated with survival using cox proportional hazards and nominal logistic regression models. Logistic regression models using salient factors were trained with 10-fold cross-validation and compared to the graded prognostic assessment (GPA) and score index of radiosurgery (SIR) using the AUC from receiver operant characteristic curves.

Results

The median survival following SRS was 1.4 and 9.2 months for the < 3 months and > 6 months groups, respectively. Age, number of brain metastases, and Karnofsky performance status were associated with overall survival while gender and interval between primary cancer and first brain metastasis diagnoses were associated with < 3 months and > 6 months survival, respectively. Models using GPA and SIR performed poorly compared to preliminary metrics generated in this study for prognosis of both < 3 months and > 6 months survival.

Conclusion

Physicians require data to provide high-value, cost-conscious health care. Clinical metrics can screen patients with asymptomatic NSCLC brain metastases likely to die prior to the standard screening interval and observation could be considered.
Appendix
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Literature
1.
go back to reference Molina JR, Yang P, Cassivi SD, Schild SE, Adjei AA (2008) Non–Small Cell Lung Cancer: Epidemiology, Risk Factors, Treatment, and Survivorship. Mayo Clin Proc 83:584–594CrossRefPubMed Molina JR, Yang P, Cassivi SD, Schild SE, Adjei AA (2008) Non–Small Cell Lung Cancer: Epidemiology, Risk Factors, Treatment, and Survivorship. Mayo Clin Proc 83:584–594CrossRefPubMed
3.
go back to reference Hazard LJ, Jensen RL, Shrieve DC (2005) Role of stereotactic radiosurgery in the treatment of brain metastases. Am J Clin Oncol 28:403–410CrossRefPubMed Hazard LJ, Jensen RL, Shrieve DC (2005) Role of stereotactic radiosurgery in the treatment of brain metastases. Am J Clin Oncol 28:403–410CrossRefPubMed
6.
go back to reference Lutterbach J, Cyron D, Henne K, Ostertag CB (2003) Radiosurgery followed by planned observation in patients with one to three brain metastases. Neurosurgery 52:1066–1073; discussion 1073–1064PubMed Lutterbach J, Cyron D, Henne K, Ostertag CB (2003) Radiosurgery followed by planned observation in patients with one to three brain metastases. Neurosurgery 52:1066–1073; discussion 1073–1064PubMed
7.
go back to reference Korones DN, Butterfield R, Meyers SP, Constine LS (2001) The role of surveillance magnetic resonance imaging (MRI) scanning in detecting recurrent brain tumors in asymptomatic children. J Neurooncol 53:33–38CrossRefPubMed Korones DN, Butterfield R, Meyers SP, Constine LS (2001) The role of surveillance magnetic resonance imaging (MRI) scanning in detecting recurrent brain tumors in asymptomatic children. J Neurooncol 53:33–38CrossRefPubMed
9.
go back to reference Sperduto PW, Kased N, Roberge D, Xu Z, Shanley R, Luo X, Sneed PK, Chao ST, Weil RJ, Suh J, Bhatt A, Jensen AW, Brown PD, Shih HA, Kirkpatrick J, Gaspar LE, Fiveash JB, Chiang V, Knisely JP, Sperduto CM, Lin N, Mehta M (2012) Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases. J Clin Oncol 30:419–425. https://doi.org/10.1200/jco.2011.38.0527 CrossRefPubMed Sperduto PW, Kased N, Roberge D, Xu Z, Shanley R, Luo X, Sneed PK, Chao ST, Weil RJ, Suh J, Bhatt A, Jensen AW, Brown PD, Shih HA, Kirkpatrick J, Gaspar LE, Fiveash JB, Chiang V, Knisely JP, Sperduto CM, Lin N, Mehta M (2012) Summary report on the graded prognostic assessment: an accurate and facile diagnosis-specific tool to estimate survival for patients with brain metastases. J Clin Oncol 30:419–425. https://​doi.​org/​10.​1200/​jco.​2011.​38.​0527 CrossRefPubMed
10.
go back to reference Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, McKenna WG, Byhardt R (1997) Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 37:745–751CrossRefPubMed Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T, McKenna WG, Byhardt R (1997) Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys 37:745–751CrossRefPubMed
12.
go back to reference Gorovets D, Department of Radiation Oncology TMC, Department of Radiation Oncology USA, USA RIH, dgorovets@tuftsmedicalcenter.org, Rava P, Department of Radiation Oncology UMMC, Ebner USA, Department of Radiation Oncology DK, Tybor RIH,USA DJ, Department of Public Health and Community Medicine TUSoM, Cielo USA, D, Department of Neurosurgery RIH, USA, Puthawala Y, Department of Radiation Oncology RIH, Kinsella USA TJ, Department of Radiation Oncology RIH, USA, DiPetrillo TA, Department of Radiation Oncology TMC, USA, Department of Radiation Oncology RIH, USA, Wazer DE, Department of Radiation Oncology TMC, USA, Department of Radiation Oncology RIH, USA, Hepel JT, Department of Radiation Oncology TMC, USA, Department of Radiation Oncology RIH, USA (2015) Predictors for Long-Term Survival Free from Whole Brain Radiation Therapy in Patients Treated with Radiosurgery for Limited Brain Metastases. Frontiers in Oncology 5 https://doi.org/10.3389/fonc.2015.00110 Gorovets D, Department of Radiation Oncology TMC, Department of Radiation Oncology USA, USA RIH, dgorovets@tuftsmedicalcenter.org, Rava P, Department of Radiation Oncology UMMC, Ebner USA, Department of Radiation Oncology DK, Tybor RIH,USA DJ, Department of Public Health and Community Medicine TUSoM, Cielo USA, D, Department of Neurosurgery RIH, USA, Puthawala Y, Department of Radiation Oncology RIH, Kinsella USA TJ, Department of Radiation Oncology RIH, USA, DiPetrillo TA, Department of Radiation Oncology TMC, USA, Department of Radiation Oncology RIH, USA, Wazer DE, Department of Radiation Oncology TMC, USA, Department of Radiation Oncology RIH, USA, Hepel JT, Department of Radiation Oncology TMC, USA, Department of Radiation Oncology RIH, USA (2015) Predictors for Long-Term Survival Free from Whole Brain Radiation Therapy in Patients Treated with Radiosurgery for Limited Brain Metastases. Frontiers in Oncology 5 https://​doi.​org/​10.​3389/​fonc.​2015.​00110
13.
go back to reference Weltman E, Salvajoli JV, Brandt RA, de Morais Hanriot R, Prisco FE, Cruz JC, de Oliveira Borges SR, Wajsbrot DB (2000) Radiosurgery for brain metastases: a score index for predicting prognosis. Int J Radiat Oncol Biol Phys 46:1155–1161CrossRefPubMed Weltman E, Salvajoli JV, Brandt RA, de Morais Hanriot R, Prisco FE, Cruz JC, de Oliveira Borges SR, Wajsbrot DB (2000) Radiosurgery for brain metastases: a score index for predicting prognosis. Int J Radiat Oncol Biol Phys 46:1155–1161CrossRefPubMed
15.
go back to reference Yamamoto M, Serizawa T, Shuto T, Akabane A, Higuchi Y, Kawagishi J, Yamanaka K, Sato Y, Jokura H, Yomo S, Nagano O, Kenai H, Moriki A, Suzuki S, Kida Y, Iwai Y, Hayashi M, Onishi H, Gondo M, Sato M, Akimitsu T, Kubo K, Kikuchi Y, Shibasaki T, Goto T, Takanashi M, Mori Y, Takakura K, Saeki N, Kunieda E, Aoyama H, Momoshima S, Tsuchiya K (2014) Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study. Lancet Oncol 15:387–395. https://doi.org/10.1016/s1470-2045(14)70061-0 CrossRefPubMed Yamamoto M, Serizawa T, Shuto T, Akabane A, Higuchi Y, Kawagishi J, Yamanaka K, Sato Y, Jokura H, Yomo S, Nagano O, Kenai H, Moriki A, Suzuki S, Kida Y, Iwai Y, Hayashi M, Onishi H, Gondo M, Sato M, Akimitsu T, Kubo K, Kikuchi Y, Shibasaki T, Goto T, Takanashi M, Mori Y, Takakura K, Saeki N, Kunieda E, Aoyama H, Momoshima S, Tsuchiya K (2014) Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study. Lancet Oncol 15:387–395. https://​doi.​org/​10.​1016/​s1470-2045(14)70061-0 CrossRefPubMed
17.
go back to reference Team RC (2014) R: A language and environment for statistical computing. 3.4.4 edn. R Foundation for Statistical Computing, Vienna Team RC (2014) R: A language and environment for statistical computing. 3.4.4 edn. R Foundation for Statistical Computing, Vienna
18.
go back to reference Delattre JY, Krol G, Thaler HT, Posner JB (1988) Distribution of brain metastases. Arch Neurol 45:741–744CrossRefPubMed Delattre JY, Krol G, Thaler HT, Posner JB (1988) Distribution of brain metastases. Arch Neurol 45:741–744CrossRefPubMed
19.
go back to reference Magnuson WJ, Lester-Coll NH, Wu AJ, Yang TJ, Lockney NA, Gerber NK, Beal K, Amini A, Patil T, Kavanagh BD, Camidge DR, Braunstein SE, Boreta LC, Balasubramanian SK, Ahluwalia MS, Rana NG, Attia A, Gettinger SN, Contessa JN, Yu JB, Chiang VL (2017) Management of Brain Metastases in Tyrosine Kinase Inhibitor-Naive Epidermal Growth Factor Receptor-Mutant Non-Small-Cell Lung Cancer: A Retrospective Multi-Institutional Analysis. J Clin Oncol 35:1070–1077. https://doi.org/10.1200/jco.2016.69.7144 CrossRefPubMed Magnuson WJ, Lester-Coll NH, Wu AJ, Yang TJ, Lockney NA, Gerber NK, Beal K, Amini A, Patil T, Kavanagh BD, Camidge DR, Braunstein SE, Boreta LC, Balasubramanian SK, Ahluwalia MS, Rana NG, Attia A, Gettinger SN, Contessa JN, Yu JB, Chiang VL (2017) Management of Brain Metastases in Tyrosine Kinase Inhibitor-Naive Epidermal Growth Factor Receptor-Mutant Non-Small-Cell Lung Cancer: A Retrospective Multi-Institutional Analysis. J Clin Oncol 35:1070–1077. https://​doi.​org/​10.​1200/​jco.​2016.​69.​7144 CrossRefPubMed
22.
go back to reference Paez JG, Janne PA, Lee JC, Tracy S, Greulich H, Gabriel S, Herman P, Kaye FJ, Lindeman N, Boggon TJ, Naoki K, Sasaki H, Fujii Y, Eck MJ, Sellers WR, Johnson BE, Meyerson M (2004) EGFR mutations in lung cancer: correlation with clinical response to gefitinib therapy. Science 304:1497–1500. https://doi.org/10.1126/science.1099314 CrossRefPubMed Paez JG, Janne PA, Lee JC, Tracy S, Greulich H, Gabriel S, Herman P, Kaye FJ, Lindeman N, Boggon TJ, Naoki K, Sasaki H, Fujii Y, Eck MJ, Sellers WR, Johnson BE, Meyerson M (2004) EGFR mutations in lung cancer: correlation with clinical response to gefitinib therapy. Science 304:1497–1500. https://​doi.​org/​10.​1126/​science.​1099314 CrossRefPubMed
23.
go back to reference Shigematsu H, Lin L, Takahashi T, Nomura M, Suzuki M, Wistuba II, Fong KM, Lee H, Toyooka S, Shimizu N, Fujisawa T, Feng Z, Roth JA, Herz J, Minna JD, Gazdar AF (2005) Clinical and biological features associated with epidermal growth factor receptor gene mutations in lung cancers. J Natl Cancer Inst 97:339–346. https://doi.org/10.1093/jnci/dji055 CrossRefPubMed Shigematsu H, Lin L, Takahashi T, Nomura M, Suzuki M, Wistuba II, Fong KM, Lee H, Toyooka S, Shimizu N, Fujisawa T, Feng Z, Roth JA, Herz J, Minna JD, Gazdar AF (2005) Clinical and biological features associated with epidermal growth factor receptor gene mutations in lung cancers. J Natl Cancer Inst 97:339–346. https://​doi.​org/​10.​1093/​jnci/​dji055 CrossRefPubMed
24.
go back to reference Iuchi T, Shingyoji M, Itakura M, Yokoi S, Moriya Y, Tamura H, Yoshida Y, Ashinuma H, Kawasaki K, Hasegawa Y, Sakaida T, Iizasa T (2015) Frequency of brain metastases in non-small-cell lung cancer, and their association with epidermal growth factor receptor mutations. Int J Clin Oncol 20:674–679. https://doi.org/10.1007/s10147-014-0760-9 CrossRefPubMed Iuchi T, Shingyoji M, Itakura M, Yokoi S, Moriya Y, Tamura H, Yoshida Y, Ashinuma H, Kawasaki K, Hasegawa Y, Sakaida T, Iizasa T (2015) Frequency of brain metastases in non-small-cell lung cancer, and their association with epidermal growth factor receptor mutations. Int J Clin Oncol 20:674–679. https://​doi.​org/​10.​1007/​s10147-014-0760-9 CrossRefPubMed
26.
go back to reference Sperduto PW, Yang TJ, Beal K, Pan H, Brown PD, Bangdiwala A, Shanley R, Yeh N, Gaspar LE, Braunstein S, Sneed P, Boyle J, Kirkpatrick JP, Mak KS, Shih HA, Engelman A, Roberge D, Arvold ND, Alexander B, Awad MM, Contessa J, Chiang V, Hardie J, Ma D, Lou E, Sperduto W, Mehta MP (2017) Estimating Survival in Patients With Lung Cancer and Brain Metastases: An Update of the Graded Prognostic Assessment for Lung Cancer Using Molecular Markers (Lung-molGPA). JAMA Oncol 3:827–831. https://doi.org/10.1001/jamaoncol.2016.3834 CrossRefPubMed Sperduto PW, Yang TJ, Beal K, Pan H, Brown PD, Bangdiwala A, Shanley R, Yeh N, Gaspar LE, Braunstein S, Sneed P, Boyle J, Kirkpatrick JP, Mak KS, Shih HA, Engelman A, Roberge D, Arvold ND, Alexander B, Awad MM, Contessa J, Chiang V, Hardie J, Ma D, Lou E, Sperduto W, Mehta MP (2017) Estimating Survival in Patients With Lung Cancer and Brain Metastases: An Update of the Graded Prognostic Assessment for Lung Cancer Using Molecular Markers (Lung-molGPA). JAMA Oncol 3:827–831. https://​doi.​org/​10.​1001/​jamaoncol.​2016.​3834 CrossRefPubMed
27.
go back to reference Lester SC, Taksler GB, Kuremsky JG, Lucas JT, Ayala-Peacock DN, Randolph DM, Bourland JD, Laxton AW, Tatter SB, Chan MD (2017) Clinical and economic outcomes of patients with brain metastases based on symptoms: An argument for routine brain screening of those treated with upfront radiosurgery. Cancer 120:433–441. https://doi.org/10.1002/cncr.28422 CrossRef Lester SC, Taksler GB, Kuremsky JG, Lucas JT, Ayala-Peacock DN, Randolph DM, Bourland JD, Laxton AW, Tatter SB, Chan MD (2017) Clinical and economic outcomes of patients with brain metastases based on symptoms: An argument for routine brain screening of those treated with upfront radiosurgery. Cancer 120:433–441. https://​doi.​org/​10.​1002/​cncr.​28422 CrossRef
31.
go back to reference Soria J-C, Ohe Y, Vansteenkiste J, Reungwetwattana T, Chewaskulyong B, Lee KH, Dechaphunkul A, Imamura F, Nogami N, Kurata T, Okamoto I, Zhou C, Cho BC, Cheng Y, Cho EK, Voon PJ, Planchard D, Su W-C, Gray JE, Lee S-M, Hodge R, Marotti M, Rukazenkov Y, Ramalingam SS (2017) Osimertinib in Untreated EGFR-Mutated Advanced Non–Small-Cell Lung Cancer. https://doi.org/10.1056/NEJMoa1713137 Soria J-C, Ohe Y, Vansteenkiste J, Reungwetwattana T, Chewaskulyong B, Lee KH, Dechaphunkul A, Imamura F, Nogami N, Kurata T, Okamoto I, Zhou C, Cho BC, Cheng Y, Cho EK, Voon PJ, Planchard D, Su W-C, Gray JE, Lee S-M, Hodge R, Marotti M, Rukazenkov Y, Ramalingam SS (2017) Osimertinib in Untreated EGFR-Mutated Advanced Non–Small-Cell Lung Cancer. https://​doi.​org/​10.​1056/​NEJMoa1713137
32.
go back to reference Goss G, Tsai CM, Shepherd FA, Ahn MJ, Bazhenova L, Crino L, de Marinis F, Felip E, Morabito A, Hodge R, Cantarini M, Johnson M, Mitsudomi T, Janne PA, Yang JC (2018) CNS response to osimertinib in patients with T790M-positive advanced NSCLC: pooled data from two phase II trials. Ann Oncol 29:687–693. https://doi.org/10.1093/annonc/mdx820 CrossRefPubMed Goss G, Tsai CM, Shepherd FA, Ahn MJ, Bazhenova L, Crino L, de Marinis F, Felip E, Morabito A, Hodge R, Cantarini M, Johnson M, Mitsudomi T, Janne PA, Yang JC (2018) CNS response to osimertinib in patients with T790M-positive advanced NSCLC: pooled data from two phase II trials. Ann Oncol 29:687–693. https://​doi.​org/​10.​1093/​annonc/​mdx820 CrossRefPubMed
33.
go back to reference Zindler JD, Jochems A, Lagerwaard FJ, Beumer R, Troost EGC, Eekers DBP, Compter I, van der Toorn PP, Essers M, Oei B, Hurkmans CW, Bruynzeel AME, Bosmans G, Swinnen A, Leijenaar RTH, Lambin P (2017) Individualized early death and long-term survival prediction after stereotactic radiosurgery for brain metastases of non-small cell lung cancer: Two externally validated nomograms. Radiother Oncol 123:189–194. https://doi.org/10.1016/j.radonc.2017.02.006 CrossRefPubMed Zindler JD, Jochems A, Lagerwaard FJ, Beumer R, Troost EGC, Eekers DBP, Compter I, van der Toorn PP, Essers M, Oei B, Hurkmans CW, Bruynzeel AME, Bosmans G, Swinnen A, Leijenaar RTH, Lambin P (2017) Individualized early death and long-term survival prediction after stereotactic radiosurgery for brain metastases of non-small cell lung cancer: Two externally validated nomograms. Radiother Oncol 123:189–194. https://​doi.​org/​10.​1016/​j.​radonc.​2017.​02.​006 CrossRefPubMed
Metadata
Title
Clinical factors associated with mortality within three months after radiosurgery of asymptomatic brain metastases from non-small cell lung cancer
Authors
Bina Kakusa
Summer Han
Sonya Aggarwal
Boxiang Liu
Gordon Li
Scott Soltys
Melanie Hayden Gephart
Publication date
01-12-2018
Publisher
Springer US
Published in
Journal of Neuro-Oncology / Issue 3/2018
Print ISSN: 0167-594X
Electronic ISSN: 1573-7373
DOI
https://doi.org/10.1007/s11060-018-03002-0

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