Improvement of Overall Survival in Patients with Brain Metastasis. An Analysis of 2003 and 2010 Cohort in a Community Oncology Center

Abstract

BACKGROUND: Emerging systemic anticancer treatments and focal CNS treatments for brain metastases (radiosurgery or surgical excision) had been shown in clinical trials to improve the survival of patients with metastatic malignancy. The extent of improvement of survival of patients with brain metastasis in community setting remained uncertain. METHODS: Consecutive patients with diagnosis of brain metastasis in the year 2003 (n = 106) and the year 2010 (n = 107) were retrospectively reviewed. CNS involvement by hematological malignancies were excluded. Univariate and multivariate analyses of prognostic factors were performed. RESULTS: Mean age of the 2003 and the 2010 cohort was 66.3 and 61.2 respectively (p = 0.004). For both of the cohorts, lung primary accounts for about 70% of cases. The patient cohort in 2010 more frequently received focal treatment for brain metastases than 2003 cohort - 18.7% vs 5.7%, (p = 0.003). Systemic treatments, including chemotherapy, hormonal therapy and targeted therapy, were more frequently given in the 2010 cohort (25.2% vs 4.7%, p < 0.0001). Median overall survival of the 2010 cohort was modestly improved by about 1 month compared with the 2003 cohort (92 days vs 63 days, p = 0.003). Improvement was mainly achieved in patients with Karnofsky Performance Status (KPS) ≥70 that 1-year survival increased from 7.2% to 31.3% (p = 0.03). In multivariate analysis, focal CNS treatment (p = 0.002), systemic treatment (p = <0.0001) and KPS ≥70 (p < 0.0001) were independent predictors of overall survival. CONCLUSIONS: Contemporary patients with brain metastasis managed in individualized basis with multidisciplinary input resulted in improvement of overall survival, especially in patients with good performance status.