Study On Clinical Characteristics And Treatment Strategy Of Lung Cancer Patients With Brain Metastases

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Study about clinical features,prognostic factors and the high-risk factors of intracranial metastases in the perhippocampus regoin in patients with lung cancerObjective We retrospectively investigated the patterns of brain metastasis,so as to explore the high-risk factors affecting hippocampus metastasis(HM)and to determine the safety of hippocampal-sparing whole brain radiotherapy(HS-WBRT)for patients with lung cancer.Methods We analyzed the clinicopathological and imaging data of consecutive lung cancer patients with metastatic disease in the brain treated at the 307 PLA hospital between January 2011 and December 2014.We evaluated the relationship between clinical factors and overall survival after brain metastases.Metastases and hippocampi were contoured in cranial magnetic resonance imaging(MRI).The closest distance from metastasis to hippocampus was calculated.Clinical and radiographic variables were correlated with perihippocampal(PH)(in or within 5mm around the hippocampus)metastasis.The risk of post-treatment PH recurrence was estimated.Result A total of 345 lung cancer patients with 1621 brain metastatic lesions were reviewed.The majority of patients were male(62.9%)and had a pathological diagnosis with adenocarcinoma.The median age diagnosed with brain metastasis was 59 years(19-84).They exhibited a median overall survival after brain metastasis(BMOS)of 11.3 months(0.1-60.6).On univariate analysis,age of brain metastasis,pathological characters,clinical stages,gene expression,initial brain metastasis,and targeted therapy significantly correlated with overall survival after brain metastasis for lung cancer patients.On multivariate analysis,only age of brain metastasis,gene expression,and targeted therapy remained significant.Hippocampal metastases were identified in 1.0%(16/1621)of metastases and 4.6%(16/345)of patients.PH lesions comprised 2.8%(45/1621)of lesions in 12.2%(42/345)of patients.The number and aggregated volume of BM were independent risk factors associated with PH disease probability on univariate analysis,while only the number of BM significantly correlated with PH disease on multivariate analysis(p=0.000,HR=1.143).One hundred and thirty nine patients without original PH lesions developed intracranial progression post-treatment.The risk of PH metastasis recurrence was 12.2%(17/139)in the PH region.Tumor stage and gene mutations and rearrangement were statistically significant predictors for BMOS.Conclusion Age of brain metastasis,gene expression,and targeted therapy are independent risk factors associated with overall survival after brain metastasis for lung cancer patients.Hippocampal metastasis is strongly associated with the number of brain metastasis.Patients with more brain metastases are more susceptible to hippocampal metastasis.HS-WBRT is considered safe and suitable for lung cancer,especially in patients with less brain metastases,early tumor stage and gene mutations and rearrangement.Part ? Targeted therapy and radiotherapy for brain metastases in non-small lung cancer patients: When is the primetime?Objective The clinical outcomes of the sequential versus concurrent therapy of targeted therapy and radiotherapy are still unconfirmed in patients with brain metastases(BM).We retrospectively reviewed our institution's experience among patients with advanced non-small cell lung cancer(NSCLC)treated with targeted therapy and radiotherapy for the brain metastases(BM),to evaluate the role of this therapeutic strategy in management of brain metastasis patients.Materials and Methods A total of 208 NSCLC patients with brain metastasis treated with targeted therapy or radiotherapy between January 2014 and December 2015 were reviewed.Thirty-seven patients underwent targeted therapy only and seventy-nine patients received radiotherapy only.The combination of targeted therapy and brain radiotherapy was performed in ninety-two patients.The combination group was stratified by prior targeted therapy,prior radiotherapy and concurrent therapies.Kaplan-Meier and Cox regression methods were performed to evaluate overall survival after brain metastasis(BMOS).Results Follow-up time was calculated from the date of CNS metastatic diagnosis.At a median follow-up of 20.8 months(range,11.1 to 64.8 months),the combination therapy showed a longer survival with median BMOS 18.7 months,comparing the targeted therapy alone and radiotherapy alone,15.1 months and 9.7 months respectively(p=0.011).In combination group,there was significant difference in the BMOS of patients with concurrent therapy,versus that of patients with sequential therapy(the median BMOS of concurrent therapy was not reached,p=0.042).Conclusion The combination of targeted therapy and brain radiotherapy showed favorite survival and provided an option for NSCLC patients with BM.Concurrent radiotherapy and targeted therapy for BM are more promising effective treatments in NSCLC patients,versus patients with prior targeted therapy or prior radiotherapy.Further prospective randomized trial with a large population is required to confirm these results.