Re‐irradiation in patients with progressive or recurrent brain metastases from extracranial solid tumors: A novel prognostic index

• Published in: Cancer medicine (Malden, MA) Vol. 12; no. 1; pp. 146 - 158
• Main Authors: Gutierrez Torres, Salvador, Maldonado Magos, Federico, Turcott, Jenny G., Hernandez‐Martinez, Juan‐Manuel, Cacho‐Díaz, Bernardo, Cardona, Andrés F., Mota‐García, Aida, Lozano Ruiz, Francisco, Ramos‐Ramirez, Maritza, Arrieta, Oscar
• Format: Journal Article
• Language: English
• Published: United States John Wiley & Sons, Inc 01.01.2023; John Wiley and Sons Inc; Wiley
• Subjects: Brain cancer; Brain Neoplasms - pathology; Breast cancer; Cancer therapies; Epidermal growth factor; Female; Histology; Humans; Lung cancer; Lymphoma; Male; Medical prognosis; Medical records; Melanoma; Metastases; Metastasis; Middle Aged; Mutation; Nervous system; Ovarian cancer; Patients; Prognosis; prognostic index score; Proportional Hazards Models; Radiation therapy; Re-Irradiation; recurrent brain metastases; re‐irradiation; repeat radiotherapy; Retrospective Studies; Sarcoma; Solid tumors; Survival; Tumors; Variables; repeat radiotherapy; recurrent brain metastases; re-irradiation; prognostic index score
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.4921

Background Most studies evaluating factors associated with the survival of patients with brain metastases (BM) have focused on patients with newly diagnosed BM. This study aimed to identify prognostic factors associated with survival after brain re‐irradiation in order to develop a new prognostic index. Methods This 5‐year retrospective study included patients treated with repeat‐radiotherapy for recurrent BM at the “Instituto Nacional de Cancerología” of Mexico between 2015 and 2019. Significant variables in the multivariate Cox regression analysis were used to create the brain re‐irradiation index (BRI). Survival and group comparisons were performed using the Kaplan–Meier method and the log‐rank test. Results Fifty‐seven patients receiving brain re‐irradiation were identified. Most patients were women (75.4%) with a mean age at BM diagnosis of 51.4 years. Lung and breast cancer were the most prevalent neoplasms (43.9% each). Independent prognostic factors for shorter survival after re‐irradiation were: Age >50 years (hazard ratio [HR]:2.5 [95% confidence interval [CI], 1.1–5.8]; p = 0.026), uncontrolled primary tumor (HR:5.5 [95% CI, 2.2–13.5]; p < 0.001), lesion size >20 mm (4.6 [95% CI, 1.7–12.2]; p = 0.002), and an interval <12 months between radiation treatments (HR:4.3 [95% CI, 1.7–10.6]; p = 0.001). Median survival (MS) after re‐irradiation was 14.6 months (95% CI, 8.2–20.9).MS of patients stratified according to the BRI score was 17.38, 10.34, and 2.82 months, with significant differences between all groups. Conclusions The new BRI can be easily implemented for the prognostic classification of cancer patients with progressive or recurrent BM from extracranial solid tumors. The BRI score is a new prognostic index that can be easily implemented in clinical practice for the prognostic classification of cancer patients with progressive or recurrent brain metastases from extracranial solid tumors