AIM: This study aimed to evaluate the clinical benefits of systemic therapy (ST) combined with stereotactic radiosurgery (SRS) for brain metastases (BM). METHODS: The patient data were extracted from the institutional disease database from 2016 to 2021. Surgical and whole-brain radiotherapy cases and poor Karnofsky performance status (KPS < 70) were excluded. The eligible patients were divided into monotherapy (SRS alone or ST alone) and combined therapy (SRS and ST, combined within a month). Univariate and multivariate Cox proportional hazards analyses were used to examine factors associated with increased risk of death and intracranial progression. The propensity score for selecting treatment was calculated based on existing prognostic covariates. Two groups were matched 1:1 and compared for intracranial progression-free survival (PFS) and overall survival (OS). RESULTS: We identified 1605 patients and analyzed 928 (monotherapy: n = 494, combined therapy: n = 434). In a multivariable model, the combined therapy was independently associated with improved PFS and OS relative to the monotherapy. At the median follow-up of 383 days in the matched dataset, the combined therapy group showed significantly longer PFS (median, 7.4 vs. 5.0 months, P < 0.001) and OS (median, 23.1 vs. 17.2 months, P = 0.036) than the monotherapy group. The overall intracranial progression and mortality risk was reduced in the combined therapy group, with an estimated HR of 0.70 and 0.78. CONCLUSIONS: Combined therapy exhibited longer PFS and OS than monotherapy in BM patients. The results support the recent trend toward combining systemic and local therapies, encouraging future clinical trials.
AIM: This study aimed to evaluate the clinical benefits of systemic therapy (ST) combined with stereotactic radiosurgery (SRS) for brain metastases (BM). METHODS: The patient data were extracted from the institutional disease database from 2016 to 2021. Surgical and whole-brain radiotherapy cases and poor Karnofsky performance status (KPS < 70) were excluded. The eligible patients were divided into monotherapy (SRS alone or ST alone) and combined therapy (SRS and ST, combined within a month). Univariate and multivariate Cox proportional hazards analyses were used to examine factors associated with increased risk of death and intracranial progression. The propensity score for selecting treatment was calculated based on existing prognostic covariates. Two groups were matched 1:1 and compared for intracranial progression-free survival (PFS) and overall survival (OS). RESULTS: We identified 1605 patients and analyzed 928 (monotherapy: n = 494, combined therapy: n = 434). In a multivariable model, the combined therapy was independently associated with improved PFS and OS relative to the monotherapy. At the median follow-up of 383 days in the matched dataset, the combined therapy group showed significantly longer PFS (median, 7.4 vs. 5.0 months, P < 0.001) and OS (median, 23.1 vs. 17.2 months, P = 0.036) than the monotherapy group. The overall intracranial progression and mortality risk was reduced in the combined therapy group, with an estimated HR of 0.70 and 0.78. CONCLUSIONS: Combined therapy exhibited longer PFS and OS than monotherapy in BM patients. The results support the recent trend toward combining systemic and local therapies, encouraging future clinical trials.
Authors: William J Magnuson; Nataniel H Lester-Coll; Abraham J Wu; T Jonathan Yang; Natalie A Lockney; Naamit K Gerber; Kathryn Beal; Arya Amini; Tejas Patil; Brian D Kavanagh; D Ross Camidge; Steven E Braunstein; Lauren C Boreta; Suresh K Balasubramanian; Manmeet S Ahluwalia; Niteshkumar G Rana; Albert Attia; Scott N Gettinger; Joseph N Contessa; James B Yu; Veronica L Chiang Journal: J Clin Oncol Date: 2017-01-23 Impact factor: 44.544
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Authors: Michael A Vogelbaum; Paul D Brown; Hans Messersmith; Priscilla K Brastianos; Stuart Burri; Dan Cahill; Ian F Dunn; Laurie E Gaspar; Na Tosha N Gatson; Vinai Gondi; Justin T Jordan; Andrew B Lassman; Julia Maues; Nimish Mohile; Navid Redjal; Glen Stevens; Erik Sulman; Martin van den Bent; H James Wallace; Jeffrey S Weinberg; Gelareh Zadeh; David Schiff Journal: J Clin Oncol Date: 2021-12-21 Impact factor: 44.544
Authors: Naren Ramakrishna; Carey K Anders; Nancy U Lin; Aki Morikawa; Sarah Temin; Sarat Chandarlapaty; Jennie R Crews; Nancy E Davidson; Maria Alice B Franzoi; Jeffrey J Kirshner; Ian E Krop; Debra A Patt; Jane Perlmutter; Sharon H Giordano Journal: J Clin Oncol Date: 2022-05-31 Impact factor: 50.717
Authors: Lu Dai; Chun-Yue Luo; Guang-Xia Hu; Gang Chen; Chuan-Xin Wu; Jun Yin; Ze-Yong Jiang; Guang-Fu Hu; Jian Zhao; Wen-Fan Fu Journal: Ann Palliat Med Date: 2020-07-15
Authors: Rashmi K Murthy; Sherene Loi; Alicia Okines; Elisavet Paplomata; Erika Hamilton; Sara A Hurvitz; Nancy U Lin; Virginia Borges; Vandana Abramson; Carey Anders; Philippe L Bedard; Mafalda Oliveira; Erik Jakobsen; Thomas Bachelot; Shlomit S Shachar; Volkmar Müller; Sofia Braga; Francois P Duhoux; Richard Greil; David Cameron; Lisa A Carey; Giuseppe Curigliano; Karen Gelmon; Gabriel Hortobagyi; Ian Krop; Sibylle Loibl; Mark Pegram; Dennis Slamon; M Corinna Palanca-Wessels; Luke Walker; Wentao Feng; Eric P Winer Journal: N Engl J Med Date: 2019-12-11 Impact factor: 91.245