Changing characteristics, treatment approaches and survival of patients with brain metastasis: data from six thousand and thirty-one individuals over an observation period of 30 years. (February 2022)

• Record Type: Journal Article
• Authors: Steindl, Ariane; Brunner, Tabea J.; Heimbach, Kira; Schweighart, Katharina; Moser, Georg M.; Niziolek, Helena M.; Moor, Elisabeth; Kreminger, Judith; Starzer, Angelika M.; Dieckmann, Karin; Gatterbauer, Brigitte; Widhalm, Georg; Preusser, Matthias; Berghoff, Anna S.
• Is Part Of: European journal of cancer. Volume 162(2022)
• Page Start: 170
• Page End: 181
• Publication Date: 2022-02
• Subjects: Brain metastasis -- Neurological symptoms in brain metastasis -- Treatment strategies in brain metastasis over the years -- Molecular information of brain metastases -- Prognosis of brain metastasis; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2021.12.005
• Languages: English
• ISSNs: 0959-8049

Abstract

Abstract: Background: An accurate classification of patients with brain metastases (BMs) is an important foundation to guide individualised treatment decisions and to formulate BM cohorts for modern clinical trials. Methods: Six thousand and thirty-one patients with newly diagnosed BM from different solid tumours treated between 1986 and 2020 were identified from the Vienna Brain Metastasis Registry. Results: A rising fraction of patients presented with asymptomatic BM during the observation period (1986–1999: 20.2% vs 2010–2020: 30.6%; p < 0.001). Especially, oncogene-addicted non-small-cell lung cancer (NSCLC) and BRAF (v-Raf murine sarcoma viral oncogene homolog)-positive melanoma had a higher rate of asymptomatic BM presentation compared with wild-type tumours (p < 0.05). Significant changes of initial BM treatment approaches were observed with a decrease of neurosurgical procedures (1986–1999: 30.8% vs 2010–2020: 19.5%) and an increase of radiation treatments (1986–1999: 65.0% vs 2010–2020: 73.3%) and systemic therapies (1986–1999: 1.0% vs 2010–2020: 2.0%; p < 0.001). Median overall survival (OS) was heterogeneous between primary tumour entities but with an overall increase over the decades (median OS 1986–1999: 5 months vs 2010–2020: 7 months; p = 0.001). Survival times were longer in patients with oncogene-addicted NSCLC, BRAF-positive melanoma and hormone receptor-positive breast cancer compared with the other cancer subtypes (p > 0.05). Conclusion: Our data highlight shifting trends in the symptomatic presentation and in treatment strategies of patients with BM over the last decades. Entity specific aspects and, in particular, the presence of targetable driver mutation impact the clinical presentation and prognosis. Future BM specific trials need to address the modern composition of BM cohorts and the distinct clinical course of patients with targetable driver mutations. Highlights: Higher prevalence of asymptomatic brain metastasis (BM) in over time. Increase of BM free survival in some primary tumour entities. Significant changes of BM treatment patterns during observation period. Survival times of patients with BM depend on primary tumour molecular profiles. Importance of entity-specific treatment approaches in planning of clinical trials.