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Recursive Partitioning Analysis Classification and graded prognostic assessment for Non-Small Cell Lung Cancer Patients with Brain Metastasis:A Retrospective Cohort Study

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Chinese Journal of Cancer Research 2011年第3期23卷 177-182页

作者： Cai-xing Sun Tao Li Xiao Zheng Ju-fen Cai Xu-li Meng Hong-jian Yang Zheng Wang Zhejiang Traditional Chinese Medicine University Hangzhou 310053 China Department of Neurooncology Hangzhou 310022 China Department of Radiation Oncology Hangzhou 310022 China Department of Medical Oncology Zhejiang Cancer Hospital Hangzhou 310022 China Zhejiang People＇s Hospital Hangzhou 310024 China

Objective：To assess prognostic factors and validate the effectiveness of recursive partitioning analysis （RPA） classes and graded prognostic assessment （GPA） in 290 non-small cell lung cancer （NSCLC） patients with brain metastasis （BM）.Methods：From Jan 2008 to Dec 2009,the clinical data of 290 NSCLC cases with BM treated with multiple modalities including brain irradiation,systemic chemotherapy and tyrosine kinase inhibitors （TKIs） in two institutes were analyzed.Survival was estimated by Kaplan-Meier method.The differences of survival rates in subgroups were assayed using log-rank test.Multivariate Cox＇s regression method was used to analyze the impact of prognostic factors on survival.Two prognostic indexes models （RPA and GPA） were validated respectively.Results：All patients were followed up for 1-44 months,the median survival time after brain irradiation and its corresponding 95% confidence interval （95% CI） was 14 （12.3-15.8） months.1-,2-and 3-year survival rates in the whole group were 56.0%,28.3%,and 12.0%,respectively.The survival curves of subgroups,stratified by both RPA and GPA,were significantly different （P0.001）.In the multivariate analysis as RPA and GPA entered Cox＇s regression model,Karnofsky performance status （KPS） ≥ 70,adenocarcinoma subtype,longer administration of TKIs remained their prognostic significance,RPA classes and GPA also appeared in the prognostic model.Conclusion：KPS ≥70,adenocarcinoma subtype,longer treatment of molecular targeted drug,and RPA classes and GPA are the independent prognostic factors affecting the survival rates of NSCLC patients with BM.

关键词： Non-small cell lung cancer （NSCLC） Brain metastasis Prognosis Recursive partitioning analysis graded prognostic assessment

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Diagnosis and management of brain metastases:an updated review from a radiation oncology perspective

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Journal of Cancer Metastasis and Treatment 2019年第7期4卷 12-27页

作者： Gutiérrez-Valencia Enrique Sánchez-Rodríguez Irving Balderrama-Ibarra Ricardo Fuentes-LaraJesús Rios-Martínez Alan Vázquez Aldana Arroyo Iñigo Bayardo-López Luis Hernández ChávezAllan Puebla-Mora Ana Graciela Nader-Roa Liliana Espíritu-Rodríguez Roque Instituto Mexicano del Seguro Social(IMSS) Departamento de Radio-OncologíaCentro Médico Nacional de OccidenteUniversidad de GuadalajaraGuadalajara 44340México Instituto Mexicano del Seguro Social(IMSS) Departamento de Anatomía PatológicaCentro Médico Nacional de OccidenteUniversidad de GuadalajaraGuadalajara 44340México Instituto Mexicano del Seguro Social(IMSS) Departamento de Física MédicaCentro Médico Nacional de OccidenteGuadalajara 44340México

Brain metastasis are the most common intracranial malignancy in the adult population. Their incidence has increased dramatically over the last 20 years, as a result of the increasing number of cases stemming from lung and breast cancer together with the higher cancer survival rates due to diagnostic and therapeutic advances. More than 40%of cancer patients develop brain metastases during the course of their disease: specifically, they appear in 50%of patients with lung cancer, more than 25% of patients with breast cancer, and 20% of patients with melanoma. Diagnosis is made using different imaging approaches, such as computed tomography and magnetic resonance imaging, accompanied by clinical manifestations and a history of malignancy supporting the diagnosis of a brain metastasis. Current treatment options should be oriented to the patient's current performance, the number of intracranial and extracranial lesions, and related factors. Although surgical resection and whole-brain radiotherapy have been standard treatments for many years, numerous treatment modalities have become more easily available and accepted worldwide, producing more favorable and reliable results. Among these is stereotactic radiosurgery, and the latest clinical trials support this treatment.

关键词： Brain metastases whole-brain radiation therapy stereotactic radiosurgery graded prognostic assessment

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