Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Rämistrasse 100, Zurich, 8091, Switzerland.
University of Zurich, Zurich, Switzerland.
Radiat Oncol. 2024 Oct 27;19(1):148. doi: 10.1186/s13014-024-02542-2.
Increasing evidence suggests that a subgroup of patients with oligometastatic cancer might achieve a prolonged disease-free survival through local therapy for all active cancer lesions. Our aims are to investigate the impact of brain metastases on the classification, treatment, and outcome in these patients.
We analyzed a total of 7,000 oncological positron emission tomography scans to identify patients with extracranial oligometastatic disease (defined as ≤ 5 intra- or extra-cranial metastases). Concurrent magnetic resonance imaging brain was assessed to quantify intracranial tumor burden. We investigated the impact of brain metastases on oligometastatic disease state, therapeutic approaches, and outcome. Predictors for transitioning from oligo- to polymetastatic states were evaluated using regression analysis.
A total of 106 patients with extracranial oligometastases and simultaneous brain metastases were identified, primarily originating from skin or lung/pleura cancers (90%, n = 96). Brain metastases caused a transition from an extracranial oligometastatic to a whole-body polymetastatic state in 45% (n = 48) of patients. While oligometastatic patients received systemic therapy (55% vs. 35%) more frequently and radiotherapy for brain metastases was more often prescribed to polymetastatic patients (44% vs. 26%), the therapeutic approach did not differ systematically between both sub-groups. The oligometastatic sub-group had a median overall survival of 28 months compared to 10 months in the polymetastatic sub-group (p < 0.01).
In patients with brain metastases, a low total tumor burden with an oligometastatic disease state remained a significant prognostic factor for overall survival. Presence of brain metastases should therefore not serve as exclusion criterion for clinical trials in the field of oligometastatic disease. Moreover, it underscores the importance of considering a multimodality treatment strategy in oligometastatic cancer patients.
越来越多的证据表明，对于存在寡转移癌症的亚组患者，通过对所有活跃的癌症病灶进行局部治疗，可能实现长期无疾病生存。我们的目的是研究脑转移对这些患者的分类、治疗和预后的影响。
我们分析了总共 7000 例肿瘤正电子发射断层扫描（PET）以识别患有颅外寡转移疾病（定义为≤5 个颅内外转移病灶）的患者。同时评估了脑磁共振成像（MRI）以量化颅内肿瘤负担。我们研究了脑转移对寡转移疾病状态、治疗方法和预后的影响。使用回归分析评估了从寡转移状态向多转移状态转变的预测因素。
共确定了 106 例存在颅外寡转移病灶和同时性脑转移的患者，主要来源于皮肤或肺/胸膜癌症（90%，n=96）。脑转移导致 45%（n=48）的患者从颅外寡转移状态转变为全身性多转移状态。尽管寡转移患者更常接受全身治疗（55% vs. 35%），且多转移患者更常接受脑转移放疗（44% vs. 26%），但这两种治疗方法在两个亚组之间没有系统差异。寡转移亚组的中位总生存期为 28 个月，而多转移亚组为 10 个月（p<0.01）。
在存在脑转移的患者中，低总肿瘤负荷和寡转移疾病状态仍然是总生存期的显著预后因素。因此，脑转移不应作为寡转移疾病临床试验的排除标准。此外，这突显了在寡转移癌症患者中考虑多模态治疗策略的重要性。
