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Predictive factors of early distant brain failure after gamma knife radiosurgery alone in patients with brain metastases of non-small-cell lung cancer

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Abstract

The objective of this study was to elucidate the predictive factors for early distant brain failure in patients with brain metastases of non-small-cell lung cancer (NSCLC) who were treated with gamma knife radiosurgery (GKRS) without previous whole-brain radiotherapy (WBRT) or surgery. We retrospectively reviewed clinical and imaging data of 459 patients with brain metastases of NSCLC who underwent GKRS from June 2008 to December 2013. The primary end-point was early distant brain failure, defined as the detection of newly developed metastatic lesions on magnetic resonance imaging (MRI) 3 months after GKRS. Factors such as tumor pathology subtype, concurrent systemic chemotherapy, epidermal growth factor receptor (EGFR) mutation status, use of EGFR tyrosine kinase inhibitors (TKIs), systemic disease status, presence of a metastatic lesion only in delayed MRI, and volume and number of metastases were analyzed. There were no statistically significant differences with respect to pathologic subtype, concurrent systemic chemotherapy, EGFR mutation, and early distant brain failure. Patients treated with EGFR-TKIs (p = 0.004), with a stable systemic disease status (p = 0.028) and 3 or fewer brain lesions (p = 0.000) experienced a significantly lower incidence of early distant brain failure. This study suggests that GKRS alone could be considered for patients treated with EGFR-TKIs who have a stable systemic disease status and 3 or fewer brain lesions. WBRT should be considered for other patients.

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Acknowledgements

This study was supported by the grant from the Basic Science Research Program (2015R1C1A1A02036851), Brain Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and Future Planning (2016M3C7A1914123) and Yonsei University Future-leading Research Initiative (Yonsei Challenge) of 2016 (2016-22-0109) The funding source had no involvement in study design etc.

Funding

This study was supported by the grant from Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT and Future Planning (2015R1C1A1A0203 6851). The funding source had no involvement in study design etc.

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Authors and Affiliations

  1. Department of Neurosurgery, Institute for Integrative medicine, Catholic Kwandong University College of Medicine, International St Mary’s Hospital, Incheon, South Korea

    Young Cheol Na

  2. Department of Neurosurgery, Brain Research Institute, Yonsei University College of Medicine, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, South Korea

    Hyun Ho Jung, Jin Woo Chang, Yong Gou Park & Won Seok Chang

  3. Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea

    Hye Ryun Kim & Byoung Chul Cho

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  1. Young Cheol Na
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Correspondence to Won Seok Chang.

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Na, Y.C., Jung, H.H., Kim, H.R. et al. Predictive factors of early distant brain failure after gamma knife radiosurgery alone in patients with brain metastases of non-small-cell lung cancer. J Neurooncol 132, 333–340 (2017). https://doi.org/10.1007/s11060-017-2373-4

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  • DOI: https://doi.org/10.1007/s11060-017-2373-4

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