Oncological Outcomes After Hippocampus-Sparing Whole-Brain Radiotherapy in Cancer Patients With Newly Diagnosed Brain Oligometastases: A Single-Arm Prospective Observational Cohort Study in Taiwan.

Shinn-Yn Lin,Cheng-Chi Lee,Wen-Chi Chou,Yi-Ming Wu,Chih-Liang Wang,Chia-Hsin Lin,Chi-Cheng Yang,Chi-Cheng Chuang,Kuo-Chen Wei,Din-Li Tsan,Ping-Ching Pai

doi:10.3389/fonc.2021.784635

Abstract

BackgroundPromisingly, the technique of hippocampus sparing during WBRT (HS-WBRT) might preserve NCFs. In this research, we examined oncological outcomes, with emphasis on neurologic/non-neurologic causes of death, CNS progression, and leptomeningeal disease (LMD) recurrence in cancer patients who underwent HS-WBRT.MethodsOne hundred and fourteen cancer patients with newly diagnosed brain oligometastases underwent HS-WBRT were consecutively enrolled. The cumulative incidence of cancer-specific deaths (neurologic or non-neurologic), LMD recurrence, and the composite endpoint of CNS progression (CNS-CE) as the first event were computed with a competing-risks approach to characterize the oncological outcomes after HS-WBRT.ResultsPatients with intact brain metastases had a significantly increased likelihood of dying from non-neurologic causes of death associated with early manifestation of progressive systemic disease (hazard ratio for non-neurologic death, 1.78; 95% CI, 1.08–2.95; p = 0.025; competing-risks Fine–Gray regression), which reciprocally rendered them unlikely to encounter LMD recurrence or any pattern of CNS progression (HR for CNS-CE as the first event, 0.13; 95% CI, 0.02–0.97; p = 0.047; competing-risks Fine–Gray regression). By contrast, patients with resection cavities post-craniotomy had reciprocally increased likelihood of CNS progression which might be associated with neurologic death eventually.ConclusionsPatterns of oncological endpoints including neurologic/non-neurologic death and cumulative incidence of CNS progression manifesting as LMD recurrence are clearly clarified and contrasted between patients with intact BMs and those with resection cavities, indicating they are clinically distinct subgroups.Trial RegistrationClinicalTrials.gov, Identifier: NCT02504788, NCT03223675.

Highlights

20%–40% of patients with brain cancer have brain metastasis (BM), resulting in poor prognosis [1]
A higher percentage of solitary BM was present in the subcohort undergoing upfront craniotomy plus tumor resection
Some clinical characteristics appeared to be associated with the occurrence of CNS progression measured as a composite endpoint (CNS-CE) without preexisting non-CNS progression or death (Table 3, Supplementary Figures 1, 2, and Figure 3). In this prospective neurocognitive study, satisfactory oncological outcomes were observed through hippocampus sparing during the whole-brain radiation therapy (WBRT) in the treatment of cancer patients who had brain oligometastases and a fair to good performance status

Summary

Introduction

20%–40% of patients with brain cancer have brain metastasis (BM), resulting in poor prognosis [1]. Whole-brain radiation therapy (WBRT), with or without surgical resection, might be the treatment of choice for managing BMs. According to the latest treatment guidelines of the National Comprehensive Cancer Network [2], surgical resection improves oncological outcomes in cancer patients with newly diagnosed BMs. Alternatively, stereotactic radiotherapy (SRS) can be used in patients with oligometastatic brain disease and surgery-related morbidities. The technique of hippocampus sparing during WBRT (HSWBRT) might preserve NCFs. In this research, we examined oncological outcomes, with emphasis on neurologic/non-neurologic causes of death, CNS progression, and leptomeningeal disease (LMD) recurrence in cancer patients who underwent HS-WBRT

Methods

Results

Discussion

Conclusion