A cure is possible: a study of 10-year survivors of brain metastases.

Abstract

Little is known on the natural history, recurrence patterns, neurocognitive outcomes and prognostic factors associated with survival in long-term survivors (≥10years) from brain metastasis (BM). In this study, the records of 1953 patients who underwent treatment for BM with a potential for ≥10years of follow-up were reviewed. Cox regression analysis identified factors predictive for overall survival (OS). The median age at brain metastasis diagnosis was 60years and the median OS was 6.4months. The 1-year OS rate was 29.9, 12.1 % at 2years, 3.0 % at 5years, and 1.3 % at 10years. On multivariable analysis, factors associated with worse OS included gender (males, HR 1.2), multiple brain metastases (HR 1.3), no surgery (HR 1.8), and no stereotactic radiosurgery (HR 1.8) (p < 0.0001 each). Fifty-six patients (2.9 %) survived ≥5years; 23 patients (1.2 %) survived ≥10years and the median survival for ≥10year survivors was 18.5years. Six of the 10-year survivors had an intracranial recurrence, five occurred within 11years from the first treatment. Presence of a solitary lesion or single lesion at the time of brain metastasis diagnosis was associated with improved survival. Eight of the ≥10year survivors (34.8 %) had no neurological symptoms at last follow-up; none of the 10-year survivors were documented to have a neurologic death. Our study demonstrates that patients with favorable prognostic features should undergo multimodality treatment. Albeit rare, patients who are alive 10years after treatment for their brain metastases may be considered cured from their intracranial disease.