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Prognostic factors and survival after whole-brain radiotherapy for initial brain metastases arising from non-small cell lung cancer

Published online by Cambridge University Press:  06 April 2021

Yukinori Okada Open the ORCID record for Yukinori Okada [Opens in a new window] ,
Mariko Kobayashi ,
Mio Shinozaki ,
Tatsuyuki Abe  and
Naoki Nakamura
Yukinori Okada*
Affiliation:
Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
Mariko Kobayashi
Affiliation:
Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
Mio Shinozaki
Affiliation:
Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
Tatsuyuki Abe
Affiliation:
Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
Naoki Nakamura
Affiliation:
Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Japan
*
Author for correspondence: Yukinori Okada, Department of Radiology, St. Marianna University School of Medicine, Kawasaki, 216-8511, Japan. E-mail: igaueno512@yahoo.co.jp
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Abstract

Aim:

To identify prognostic factors and investigate patient survival after whole-brain radiotherapy (WBRT) for initial brain metastases arising from non-small cell lung cancer (NSCLC).

Methods:

Patients diagnosed with NSCLC between 1 January 2010 and 30 September 2019, and who received WBRT upon first developing a brain metastasis, were investigated. Overall survival was determined as related to age, sex, duration between initial examination and brain metastasis detection, stage at the first examination, presence of metastases outside the brain, blood analysis findings, brain metastasis symptoms, radiotherapy dose and completion, imaging findings, therapeutic course of chemotherapy and/or radiation therapy, histological type, and gene mutation status.

Results:

Thirty-one consecutive patients (20 men and 11 women) with a mean age of 63·8 years and median survival of 129 days were included. Multivariate analysis with stepwise testing was performed to investigate differences in survival according to gene mutation status, lactate dehydrogenase (LDH) level, irradiation dose, WBRT completion and Stage status. Of these, a statistically significant difference in survival was observed in patients with gene mutation status (hazard ratio: 0·31, 95% CI: 0·11–0·86, p = 0·025), LDH levels <230 vs. ≥230 IU/L (hazard ratio: 4·08, 95% CI: 1·45–11·5, p < 0·01) received 30 Gy, 30 Gy/10 fractions to 35 Gy/14 fractions, and 37·5 Gy/15 fractions (hazard ratio: 0·26, 95% CI: 0·09–0·71, p < 0·01), and stage IV versus non-stage IV (hazard ratio: 0·13, 95 CI:0·02–0·64, p < 0·01)

Findings:

Gene mutation, LDH, radiation dose and Stage are prognostic factors for patients with initial brain metastases who are treated with WBRT.

Keywords

brain metastasislactate dehydrogenasenon-small cell lung cancerwhole-brain radiotherapy
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 21 , Issue 3 , September 2022 , pp. 360 - 365
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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