Department of Radiation Oncology, Aichi Cancer Center Hospital, Nagoya, Japan.
Jpn J Clin Oncol. 2023 Jun 29;53(7):572-580. doi: 10.1093/jjco/hyad026.
We aimed to evaluate recent trends in characteristics and treatments among patients with brain metastases in clinical practice.
All newly diagnosed patients with brain metastases during 2016-2021 at a single cancer center were enrolled. We collected the detailed features of each patient and estimated the number of candidates considered to meet the following criteria used in common clinical trials: Karnofsky performance status ≥ 70 and mutated non-small cell lung cancer, breast cancer or melanoma. The brain metastases treatments were classified as follows: (i) stereotactic radiosurgery, (ii) stereotactic radiosurgery and systemic therapy, (iii) whole-brain radiotherapy, (iv) whole-brain radiotherapy and systemic therapy, (v) surgery, (vi) immune checkpoint inhibitor or targeted therapy, (vii) cytotoxic agents and (ix) palliative care. Overall survival and intracranial progression-free survival were estimated from brain metastases diagnosis to death or intracranial progression.
A total of 800 brain metastases patients were analyzed; 597 (74.6%) underwent radiotherapy, and 422 (52.7%) underwent systemic therapy. In addition, 250 (31.3%) patients were considered candidates for common clinical trials. Compared to 2016, the later years tended to shift from whole-brain radiotherapy to stereotactic radiosurgery (whole-brain radiotherapy: 35.7-29.1% and stereotactic radiosurgery: 33.4-42.8%) and from cytotoxic agents to immune checkpoint inhibitor/targeted therapy (cytotoxic agents: 10.1-5.0 and immune checkpoint inhibitor/targeted therapy: 7.8-10.9%). There was also an increase in the proportion of systemic therapy combined with radiation therapy (from 26.4 to 36.5%). The median overall survival and progression-free survival were 12.7 and 5.3 months, respectively.
This study revealed the diversity of brain metastases patient characteristics, recent changes in treatment selection and the percentage of candidates in clinical trials.
我们旨在评估在临床实践中脑转移患者的特征和治疗方法的最新趋势。
在一家癌症中心，所有在 2016 年至 2021 年间新诊断为脑转移的患者均被纳入研究。我们收集了每位患者的详细特征，并估计了符合以下常见临床试验标准的候选人数：卡氏行为状态评分≥70 分且存在非小细胞肺癌、乳腺癌或黑色素瘤的突变。脑转移的治疗方法如下：（i）立体定向放射外科手术，（ii）立体定向放射外科手术和系统治疗，（iii）全脑放疗，（iv）全脑放疗和系统治疗，（v）手术，（vi）免疫检查点抑制剂或靶向治疗，（vii）细胞毒性药物和（ix）姑息治疗。从脑转移诊断到死亡或颅内进展，我们对总生存期和颅内无进展生存期进行了估计。
共分析了 800 例脑转移患者；597 例（74.6%）接受了放疗，422 例（52.7%）接受了系统治疗。此外，250 例（31.3%）患者被认为是常见临床试验的候选者。与 2016 年相比，近年来放疗方式从全脑放疗向立体定向放射外科手术转变（全脑放疗：35.7-29.1%和立体定向放射外科手术：33.4-42.8%），细胞毒性药物向免疫检查点抑制剂/靶向治疗转变（细胞毒性药物：10.1-5.0%和免疫检查点抑制剂/靶向治疗：7.8-10.9%）。联合放疗的系统治疗比例也有所增加（从 26.4%增加到 36.5%）。中位总生存期和无进展生存期分别为 12.7 个月和 5.3 个月。
本研究揭示了脑转移患者特征的多样性、治疗选择的最新变化以及临床试验中的候选者比例。
