Journal ArticleDOI
A Multi-institutional Prospective Observational Study of Stereotactic Radiosurgery for Patients With Multiple Brain Metastases (JLGK0901 Study Update): Irradiation-related Complications and Long-term Maintenance of Mini-Mental State Examination Scores.
Masaaki Yamamoto,Toru Serizawa,Yoshinori Higuchi,Yasunori Sato,Jun Kawagishi,Kazuhiro Yamanaka,Takashi Shuto,Atsuya Akabane,Hidefumi Jokura,Shoji Yomo,Osamu Nagano,Hidefumi Aoyama +11 more
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This longer-term follow-up study further supports the already-reported noninferiority hypothesis of SRS alone for patients with 5 to 10 BMs versus 2 to 4 BMs.Abstract:
Purpose The JLGK0901 study showed the noninferiority of stereotactic radiosurgery (SRS) alone as initial treatment of 5 to 10 brain metastases (BMs) compared with 2 to 4 BMs in terms of overall survival and most secondary endpoints (Lancet Oncol 2014;15:387-95). However, observation periods were not long enough to allow confirmation of the long-term safety of SRS alone in patients with 5 to 10 BMs. Methods and Materials This was a prospective observational study of Gamma Knife SRS-treated patients with 1 to 10 newly diagnosed BMs enrolled at 23 facilities between March 1, 2009, and February 15, 2012. Results The 1194 eligible patients were categorized into the following groups: group A, 1 tumor (n=455); group B, 2 to 4 tumors (n=531); and group C, 5 to 10 tumors (n=208). Cumulative rates of Mini-Mental State Examination (MMSE) score maintenance (MMSE score decrease P =.18; HR of group B vs group C, 1.280; 95% CI, 0.696-2.508; P =.43). During observations ranging from 0.3 to 67.5 months (median, 12.0 months; interquartile range, 5.8-26.5 months), as of December 2014, 145 patients (12.1%) had SRS-induced complications. Cumulative complication incidences by competing risk analysis for groups A, B, and C were 7%, 8%, and 6%, respectively, at the 12th month after SRS; 10%, 11%, and 11%, respectively, at the 24th month; 11%, 11%, and 12%, respectively, at the 36th month; and 12%, 12%, and 13%, respectively, at the 48th month (HR of group A vs group B, 0.850; 95% CI, 0.592-1.220; P =.38; HR of group B vs group C, 1.052; 95% CI, 0.666-1.662, P =.83). Leukoencephalopathy occurred in 12 of the 1074 patients (1.1%) with follow-up magnetic resonance imaging and was detected after salvage whole-brain radiation therapy in 11 of these 12 patients. In these 11 patients, leukoencephalopathy was detected by magnetic resonance imaging 5.2 to 21.2 months (median, 11.0 months; interquartile range, 7.0-14.4 months) after whole-brain radiation therapy. Conclusions Neither MMSE score maintenance nor post-SRS complication incidence differed among groups A, B, and C. This longer-term follow-up study further supports the already-reported noninferiority hypothesis of SRS alone for patients with 5 to 10 BMs versus 2 to 4 BMs.read more
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EANO-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with leptomeningeal metastasis from solid tumours.
E. Le Rhun,Michael Weller,Dieta Brandsma,M. J. van den Bent,E. de Azambuja,Roger Henriksson,Thomas Boulanger,Solange Peters,Colin Watts,Wolfgang Wick,Wolfgang Wick,Pieter Wesseling,Pieter Wesseling,Roberta Rudà,Matthias Preusser +14 more
TL;DR: The EANO-ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up of patients with leptomeningeal metastasis from solid tumours are published.
Journal ArticleDOI
Current approaches to the management of brain metastases.
TL;DR: Stereotactic radiosurgery (SRS) is now the primary treatment for patients with either limited or multiple brain metastases, with potential synergistic effects when combined with certain immunotherapeutic agents or targeted therapies.
Journal ArticleDOI
Pan-Asian adapted Clinical Practice Guidelines for the management of patients with metastatic non-small-cell lung cancer: a CSCO–ESMO initiative endorsed by JSMO, KSMO, MOS, SSO and TOS
Y-L. Wu,David Planchard,S-N Lu,H Sun,Noboru Yamamoto,D-W. Kim,Daniel Shao-Weng Tan,J.C.-H. Yang,M Azrif,Tetsuya Mitsudomi,Kwang Bo Park,Ross A. Soo,J W C Chang,Adlinda Alip,Solange Peters,J.-Y. Douillard +15 more
TL;DR: These guidelines represent the consensus opinions reached by experts in the treatment of patients with metastatic NSCLC representing the oncological societies of China (CSCO), Japan (JSMO), Korea (KSMO), Malaysia (MOS), Singapore (SSO) and Taiwan (TOS) and were considered, during the final stages of the development of the Pan-Asian adapted Clinical Practice Guidelines.
Journal ArticleDOI
Treatment strategies for breast cancer brain metastases
TL;DR: An overview of the therapeutic option for BCBM that is currently available is provided and potential new approaches for tackling these deadly secondary tumours are outlined.
Journal ArticleDOI
Imaging challenges of immunotherapy and targeted therapy in patients with brain metastases: response, progression, and pseudoprogression.
Norbert Galldiks,Norbert Galldiks,Martin Kocher,Martin Kocher,Garry Ceccon,Jan-Michael Werner,Anna Brunn,Martina Deckert,Whitney B. Pope,Riccardo Soffietti,Emilie Le Rhun,Michael Weller,Joerg C. Tonn,Gereon R. Fink,Gereon R. Fink,Karl-Josef Langen +15 more
TL;DR: This review aims at summarizing the imaging challenges related to TT and ICI monotherapy as well as combined with radiotherapy in patients with brain metastases, and to give an overview on advanced imaging techniques which potentially overcome some of these imaging challenges.
References
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Journal ArticleDOI
A Proportional Hazards Model for the Subdistribution of a Competing Risk
Jason P. Fine,Robert Gray +1 more
TL;DR: This article proposes methods for combining estimates of the cause-specific hazard functions under the proportional hazards formulation, but these methods do not allow the analyst to directly assess the effect of a covariate on the marginal probability function.
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Estimation of failure probabilities in the presence of competing risks: new representations of old estimators
Ted Gooley,Ted Gooley,Wendy M. Leisenring,Wendy M. Leisenring,John Crowley,John Crowley,Barry E. Storer,Barry E. Storer +7 more
TL;DR: A representation of each estimate in a manner not ordinarily seen is presented, each representation utilizing the concept of censored observations being 'redistributed to the right' to allow a more intuitive understanding of each estimates.
Journal ArticleDOI
Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial.
Eric L. Chang,Jeffrey S. Wefel,Kenneth R. Hess,Pamela K. Allen,Frederick F. Lang,David G. Kornguth,Rebecca Arbuckle,J. Michael Swint,Almon S. Shiu,Moshe H. Maor,Christina A. Meyers +10 more
TL;DR: Patients treated with SRS plus WBRT were at a greater risk of a significant decline in learning and memory function by 4 months compared with the group that received SRS alone, and patients treatment with a combination of SRS and close clinical monitoring was recommended as the preferred treatment strategy.
Journal ArticleDOI
Stereotactic Radiosurgery Plus Whole-Brain Radiation Therapy vs Stereotactic Radiosurgery Alone for Treatment of Brain Metastases: A Randomized Controlled Trial
Hidefumi Aoyama,Hiroki Shirato,Masao Tago,Keiichi Nakagawa,Tatsuya Toyoda,Kazuo Hatano,M. Kenjyo,Natsuo Oya,Saeko Hirota,Hiroki Shioura,Etsuo Kunieda,Taisuke Inomata,Kazushige Hayakawa,Norio Katoh,Gen Kobashi +14 more
TL;DR: Compared with SRS alone, the use of W BRT plus SRS did not improve survival for patients with 1 to 4 brain metastases, but intracranial relapse occurred considerably more frequently in those who did not receive WBRT.
Journal ArticleDOI
Effect of Radiosurgery Alone vs Radiosurgery With Whole Brain Radiation Therapy on Cognitive Function in Patients With 1 to 3 Brain Metastases: A Randomized Clinical Trial
Paul D. Brown,Kurt A. Jaeckle,Karla V. Ballman,Elana Farace,Jane H. Cerhan,S. Keith Anderson,Xiomara W. Carrero,Fred G. Barker,Richard L. Deming,Stuart H. Burri,Cynthia Ménard,Cynthia Ménard,Caroline Chung,Volker W. Stieber,Bruce E. Pollock,Evanthia Galanis,Jan C. Buckner,Anthony L. Asher +17 more
TL;DR: Among patients with 1 to 3 brain metastases, the use of SRS alone, compared with SRS combined with WBRT, resulted in less cognitive deterioration at 3 months, and in the absence of a difference in overall survival, these findings suggest that.