Long-term survival in patients with brain metastases-clinical characterization of arare scenario.

Abstract

This study aimed to assess clinical, treatment, and prognostic features in patients with brain metastases (BM) from solid tumors achieving long-term survival (LTS). Further, the accuracy of diagnosis-specific Graded Prognostic Assessment scores (ds-GPA) to predict LTS was evaluated. Patients admitted for radiotherapy of BM between 2010 and 2020 at alarge tertiary cancer center with survival of at least 3years from diagnosis of BM were included. Patient, tumor, treatment characteristics and ds-GPA were compiled retrospectively. From atotal of 1248patients with BM, 61 (4.9%) survived ≥ 3years. In 40patients, detailed patient charts were available. Among LTS patients, median survival time from diagnosis of BM was 51.5months. Most frequent primary tumors were lung cancer (45%), melanoma (20%), and breast cancer (17.5%). At the time of diagnosis of BM, 11/40patients (27.5%) had oligometastatic disease. Estimated mean survival time based on ds-GPA was 19.7months (in 8cases estimated survival < 12months). Resection followed by focal or whole-brain radiotherapy (WBRT) was often applied (60%), followed by primary stereotactic radiotherapy (SRT) (20%) or WBRT (20%). 80% of patients received systemic treatment, appearing particularly active in specifically altered non-small lung cancer (NSCLC), melanoma, and HER2-positive breast cancer. Karnofsky performance score (KPS) and the presence of oligometastatic disease at BM diagnosis were persisting prognostic factors in LTS patients. In this monocentric setting reflecting daily pattern of care, LTS with BM is heterogeneous and difficult to predict. Effective local treatment and modern systemic therapies often appear crucial for LTS. The impact of concomitant diseases and frailty is not clear.