Prognostic factors in patients with non-small cell lung carcinoma and brain metastases: A malaysian perspective

Weng Heng Tang, Adlinda Alip, Marniza Saad, Vincent Chee Ee Phua, Hari Chandran, Yi Hang Tan, Yan Yin Tan, Voon Fong Kua, Mohamed Ibrahim Wahid, Lye Mun Tho

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: Brain metastases occur in about 20-40% of patients with non-small-cell lung carcinoma (NSCLC), and are usually associated with a poor outcome. Whole brain radiotherapy (WBRT) is widely used but increasingly, more aggressive local treatments such as surgery or stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) are being employed. In our study we aimed to describe the various factors affecting outcomes in NSCLC patients receiving local therapy for brain metastases. Materials and Methods: The case records of 125 patients with NSCLC and brain metastases consecutively treated with radiotherapy at two tertiary centres from January 2006 to June 2012 were analysed for patient, tumour and treatment-related prognostic factors. Patients receiving SRS/SRT were treated using Cyberknife. Variables were examined in univariate and multivariate testing. Results: Overall median survival was 3.4 months (95%CI: 1.7-5.1). Median survival for patients with multiple metastases receiving WBRT was 1.5 months, 1-3 metastases receiving WBRT was 3.6 months and 1-3 metastases receiving surgery or SRS/SRT was 8.9 months. ECOG score (≤2 vs >2, p=0.001), presence of seizure (yes versus no, p=0.031), treatment modality according to number of brain metastases (1-3 metastases+surgery or SRS/SRT±WBRT vs 1-3 metastases+WBRT only vs multiple metastases+WBRT only, p=0.007) and the use of post-therapy systemic treatment (yes versus no, p=0.001) emerged as significant on univariate analysis. All four factors remained statistically significant on multivariate analysis. Conclusions: ECOG ≤2, presence of seizures, oligometastatic disease treated with aggressive local therapy (surgery or SRS/SRT) and the use of post-therapy systemic treatment are favourable prognostic factors in NSCLC patients with brain metastases.

Original languageEnglish
Pages (from-to)1901-1906
Number of pages6
JournalAsian Pacific Journal of Cancer Prevention
Volume16
Issue number5
DOIs
Publication statusPublished - 2015
Externally publishedYes

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Non-Small Cell Lung Carcinoma
Radiotherapy
Neoplasm Metastasis
Brain
Radiosurgery
Therapeutics
Seizures
Survival
Multivariate Analysis

Keywords

  • Brain metastases
  • Cyberknife
  • Non-small cell lung carcinoma
  • Stereotactic radiosurgery

ASJC Scopus subject areas

  • Oncology
  • Cancer Research
  • Public Health, Environmental and Occupational Health
  • Epidemiology

Cite this

Prognostic factors in patients with non-small cell lung carcinoma and brain metastases : A malaysian perspective. / Tang, Weng Heng; Alip, Adlinda; Saad, Marniza; Phua, Vincent Chee Ee; Chandran, Hari; Tan, Yi Hang; Tan, Yan Yin; Kua, Voon Fong; Wahid, Mohamed Ibrahim; Tho, Lye Mun.

In: Asian Pacific Journal of Cancer Prevention, Vol. 16, No. 5, 2015, p. 1901-1906.

Research output: Contribution to journalArticle

Tang, WH, Alip, A, Saad, M, Phua, VCE, Chandran, H, Tan, YH, Tan, YY, Kua, VF, Wahid, MI & Tho, LM 2015, 'Prognostic factors in patients with non-small cell lung carcinoma and brain metastases: A malaysian perspective', Asian Pacific Journal of Cancer Prevention, vol. 16, no. 5, pp. 1901-1906. https://doi.org/10.7314/APJCP.2015.16.5.1901
Tang, Weng Heng ; Alip, Adlinda ; Saad, Marniza ; Phua, Vincent Chee Ee ; Chandran, Hari ; Tan, Yi Hang ; Tan, Yan Yin ; Kua, Voon Fong ; Wahid, Mohamed Ibrahim ; Tho, Lye Mun. / Prognostic factors in patients with non-small cell lung carcinoma and brain metastases : A malaysian perspective. In: Asian Pacific Journal of Cancer Prevention. 2015 ; Vol. 16, No. 5. pp. 1901-1906.
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abstract = "Background: Brain metastases occur in about 20-40{\%} of patients with non-small-cell lung carcinoma (NSCLC), and are usually associated with a poor outcome. Whole brain radiotherapy (WBRT) is widely used but increasingly, more aggressive local treatments such as surgery or stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) are being employed. In our study we aimed to describe the various factors affecting outcomes in NSCLC patients receiving local therapy for brain metastases. Materials and Methods: The case records of 125 patients with NSCLC and brain metastases consecutively treated with radiotherapy at two tertiary centres from January 2006 to June 2012 were analysed for patient, tumour and treatment-related prognostic factors. Patients receiving SRS/SRT were treated using Cyberknife. Variables were examined in univariate and multivariate testing. Results: Overall median survival was 3.4 months (95{\%}CI: 1.7-5.1). Median survival for patients with multiple metastases receiving WBRT was 1.5 months, 1-3 metastases receiving WBRT was 3.6 months and 1-3 metastases receiving surgery or SRS/SRT was 8.9 months. ECOG score (≤2 vs >2, p=0.001), presence of seizure (yes versus no, p=0.031), treatment modality according to number of brain metastases (1-3 metastases+surgery or SRS/SRT±WBRT vs 1-3 metastases+WBRT only vs multiple metastases+WBRT only, p=0.007) and the use of post-therapy systemic treatment (yes versus no, p=0.001) emerged as significant on univariate analysis. All four factors remained statistically significant on multivariate analysis. Conclusions: ECOG ≤2, presence of seizures, oligometastatic disease treated with aggressive local therapy (surgery or SRS/SRT) and the use of post-therapy systemic treatment are favourable prognostic factors in NSCLC patients with brain metastases.",
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T1 - Prognostic factors in patients with non-small cell lung carcinoma and brain metastases

T2 - A malaysian perspective

AU - Tang, Weng Heng

AU - Alip, Adlinda

AU - Saad, Marniza

AU - Phua, Vincent Chee Ee

AU - Chandran, Hari

AU - Tan, Yi Hang

AU - Tan, Yan Yin

AU - Kua, Voon Fong

AU - Wahid, Mohamed Ibrahim

AU - Tho, Lye Mun

PY - 2015

Y1 - 2015

N2 - Background: Brain metastases occur in about 20-40% of patients with non-small-cell lung carcinoma (NSCLC), and are usually associated with a poor outcome. Whole brain radiotherapy (WBRT) is widely used but increasingly, more aggressive local treatments such as surgery or stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) are being employed. In our study we aimed to describe the various factors affecting outcomes in NSCLC patients receiving local therapy for brain metastases. Materials and Methods: The case records of 125 patients with NSCLC and brain metastases consecutively treated with radiotherapy at two tertiary centres from January 2006 to June 2012 were analysed for patient, tumour and treatment-related prognostic factors. Patients receiving SRS/SRT were treated using Cyberknife. Variables were examined in univariate and multivariate testing. Results: Overall median survival was 3.4 months (95%CI: 1.7-5.1). Median survival for patients with multiple metastases receiving WBRT was 1.5 months, 1-3 metastases receiving WBRT was 3.6 months and 1-3 metastases receiving surgery or SRS/SRT was 8.9 months. ECOG score (≤2 vs >2, p=0.001), presence of seizure (yes versus no, p=0.031), treatment modality according to number of brain metastases (1-3 metastases+surgery or SRS/SRT±WBRT vs 1-3 metastases+WBRT only vs multiple metastases+WBRT only, p=0.007) and the use of post-therapy systemic treatment (yes versus no, p=0.001) emerged as significant on univariate analysis. All four factors remained statistically significant on multivariate analysis. Conclusions: ECOG ≤2, presence of seizures, oligometastatic disease treated with aggressive local therapy (surgery or SRS/SRT) and the use of post-therapy systemic treatment are favourable prognostic factors in NSCLC patients with brain metastases.

AB - Background: Brain metastases occur in about 20-40% of patients with non-small-cell lung carcinoma (NSCLC), and are usually associated with a poor outcome. Whole brain radiotherapy (WBRT) is widely used but increasingly, more aggressive local treatments such as surgery or stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) are being employed. In our study we aimed to describe the various factors affecting outcomes in NSCLC patients receiving local therapy for brain metastases. Materials and Methods: The case records of 125 patients with NSCLC and brain metastases consecutively treated with radiotherapy at two tertiary centres from January 2006 to June 2012 were analysed for patient, tumour and treatment-related prognostic factors. Patients receiving SRS/SRT were treated using Cyberknife. Variables were examined in univariate and multivariate testing. Results: Overall median survival was 3.4 months (95%CI: 1.7-5.1). Median survival for patients with multiple metastases receiving WBRT was 1.5 months, 1-3 metastases receiving WBRT was 3.6 months and 1-3 metastases receiving surgery or SRS/SRT was 8.9 months. ECOG score (≤2 vs >2, p=0.001), presence of seizure (yes versus no, p=0.031), treatment modality according to number of brain metastases (1-3 metastases+surgery or SRS/SRT±WBRT vs 1-3 metastases+WBRT only vs multiple metastases+WBRT only, p=0.007) and the use of post-therapy systemic treatment (yes versus no, p=0.001) emerged as significant on univariate analysis. All four factors remained statistically significant on multivariate analysis. Conclusions: ECOG ≤2, presence of seizures, oligometastatic disease treated with aggressive local therapy (surgery or SRS/SRT) and the use of post-therapy systemic treatment are favourable prognostic factors in NSCLC patients with brain metastases.

KW - Brain metastases

KW - Cyberknife

KW - Non-small cell lung carcinoma

KW - Stereotactic radiosurgery

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