Clinicopathologic and Treatment Features of Long-Term Surviving Brain Metastasis Patients

• Main Authors: Archya Dasgupta, Jayson Co, Jeff Winter, Barbara-Ann Millar, Normand Laperriere, Derek S. Tsang, Monique van Prooijen, Andrei Damyanovich, Robert Heaton, Catherine Coolens, Mark Bernstein, Paul Kongkham, Gelareh Zadeh, Alejandro Berlin, Tatiana Conrad, Fabio Y. Moraes, David B. Shultz
• Format: Article
• Language: English
• Published: MDPI AG 2021-01-01
• Series: Current Oncology
• Subjects: brain metastasis; long-term survivors; molecular characteristics; systemic therapy; targeted therapy; immunotherapy
• Online Access: https://www.mdpi.com/1718-7729/28/1/54
• ISSN: 1198-0052; 1718-7729

Background: The purpose of our study was to characterize clinical features among brain metastasis (BM) patients who were long term survivors (LTS). Methods: We reviewed a registry of BM patients referred to our multidisciplinary BM clinic between 2006 and 2014 and identified 97 who lived ≥ 3 years following BM diagnosis. The clinical and treatment characteristics were obtained from a prospectively maintained database, and additional information was obtained through review of electronic medical records and radiologic images. Survival analyses were performed using the Kaplan-Meier method. Results: Median follow up for LTS was 67 months (range 36–181). Median age was 54 years, 65% had single BM, 39% had stable extracranial disease at the time of BM treatment, and brain was the first site of metastasis in 76%. Targetable mutations were present in 39% of patients and 66% received treatment with targeted-, hormonal-, or immuno-therapy. Brain surgery at the time of diagnosis was performed in 40% and stereotactic radiosurgery (SRS) or whole brain radiotherapy (alone or combination) in 52% and 56%, respectively. Following initial BM treatment, 5-year intracranial disease-free survival was 39%, and the cumulative incidence of symptomatic radio-necrosis was 16%. Five and ten-year overall survival was 72% and 26%, respectively. Conclusion: Most LTS were younger than 60 years old and had a single BM. Many received treatment with surgery or targeted, immune, or hormonal therapy.