1Department of Radiation Oncology, Incheon St. Mary Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
2Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Seoul, Korea
3Department of Radiation Oncology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
4Department of Radiation Oncology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
5Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
Copyright © 2024 by the Korean Cancer Association
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Ethical Statement
This study was approved by the Institutional Review Boards of the two institutions (2023-11-013 and OC24RIDI0015). The requirement for informed consent was waived.
Author Contributions
Conceived and designed the analysis: Kim M, Cha J, Kim HJ, Kim WC, Lee J.
Collected the data: Kim M, Cha J, Lee J.
Contributed data or analysis tools: Kim M, Lee J.
Performed the analysis: Kim M, Cha J, Lee J.
Wrote the paper: Kim M, Lee J.
Paper review: Kim HJ, Kim WC, Lee J.
Conflict of Interest
Conflict of interest relevant to this article was not reported.
Variable |
Univariate analysis |
Multivariate analysisa) |
|||
---|---|---|---|---|---|
1-Year OS (%) | 2-Year OS (%) | p-value | Hazard ratio (95% CI) | p-value | |
Age (yr) | |||||
65-70 | 77.2 | 65.0 | 0.499 | - | - |
> 70 | 63.9 | 41.0 | - | - | |
GPA score | |||||
0.5 | 24.8 | 12.4 | < 0.001 | Ref | < 0.001 |
1.0-2.5 | 75.5 | 62.9 | 0.127 (0.047-0.344) | < 0.001 | |
3 | 87.5 | 72.9 | 0.083 (0.020-0.338) | 0.001 | |
Total BM volume (mm3) | |||||
≤ 1,300 | 72.0 | 60.4 | 0.258 | - | - |
> 1,300 | 67.4 | 51.5 | - | - | |
No. of BM | |||||
1-3 | 74.9 | 61.7 | 0.034 | Ref | 0.103 |
≥ 4 | 48.1 | 32.1 | 0.385 (0.122-1.215) | - | |
Primary controlled | |||||
Controlled | 76.7 | 64.1 | 0.335 | - | - |
No controlled | 66.7 | 52.2 | - | - | |
Systemic therapy | |||||
No | 45.5 | 22.7 | 0.004 | Ref | 0.015 |
Cytotoxic agent | 71.7 | 54.5 | 0.449 (0.179-1.131) | 0.089 | |
Targeted agent | 76.1 | 67.8 | 0.215 (0.074-0.622) | 0.005 | |
Immunotherapy | |||||
No | 69.0 | 53.2 | 0.744 | - | - |
Yes | 73.0 | 65.7 | - | - | |
BED (Gy) | |||||
< 60.0 | 70.5 | 57.5 | 0.735 | - | - |
≥ 60.0 | 68.9 | 54.6 | - | - |
Variable |
Univariate analysis |
Multivariate analysisa) |
|||
---|---|---|---|---|---|
1-Year IFLC (%) | 2-Year IFLC (%) | p-value | Hazard ratio (95% CI) | p-value | |
Age (yr) | |||||
65-70 | 73.8 | 54.1 | 0.308 | - | - |
> 70 | 80.2 | 64.8 | - | - | |
GPA score | |||||
0.5 | 31.2 | 31.2 | 0.030 | - | - |
1.0-2.5 | 77.7 | 54.2 | - | ||
3 | 100 | 100 | - | ||
Total BM volume (mm3) | |||||
≤ 1,300 | 77.6 | 73.5 | 0.005 | Ref | 0.040 |
> 1,300 | 74.4 | 35.8 | 2.410 (1.042-5.576) | ||
No. of BM | |||||
1-3 | 79.6 | 63.8 | 0.014 | Ref | 0.022 |
≥ 4 | 55.8 | 18.6 | 2.962 (1.169-7.504) | ||
Primary controlled | |||||
Controlled | 77.0 | 57.0 | 0.890 | - | - |
No controlled | 75.2 | 57.9 | - | ||
Systemic therapy | |||||
No | 69.4 | 69.4 | 0.630 | - | - |
Cytotoxic agent | 72.4 | 51.7 | - | ||
Targeted agent | 84.5 | 67.3 | - | ||
Immunotherapy | |||||
No | 74.5 | 53.5 | 0.162 | - | - |
Yes | 80.8 | 70.7 | - | ||
BED (Gy) | |||||
< 60.0 | 68.3 | 37.7 | 0.031 | - | - |
≥ 60.0 | 84.5 | 79.3 | - |
BED, biological equivalent dose; BM, brain metastasis; CI, confidence interval; GPA, graded prognostic assessment; IFLC, in-field local control; Ref, reference.
a) Variables were entered into the multivariate regression model in a stepwise method if p ≤ 0.10 and were removed at any point if p > 0.10.
Variable | No. (%) (n=91) |
---|---|
Age (yr) | |
Median (range) | 70 (65-89) |
65-70 | 49 (53.8) |
> 70 | 42 (46.2) |
Sex | |
Male | 52 (57.1) |
Female | 39 (42.9) |
KPS | |
70-80 | 52 (57.1) |
90-100 | 39 (42.9) |
Pathology | |
Adenocarcinoma | 11 (12.1) |
Squamous cell carcinoma | 75 (82.4) |
Others | 5 (5.5) |
No. of BM | |
Median (range) | 2 (1-10) |
1 | 44 (48.4) |
2-4 | 36 (39.6) |
> 5 | 11 (12.1) |
Total BM volume (mm3) | |
Median (range) | 1,275 (24-81,842) |
Mean±SD | 4,389±10,970 |
≤ 1,300 | 46 (50.5) |
> 1,300 | 45 (49.5) |
Primary controlled | |
No | 28 (30.8) |
Yes | 63 (69.2) |
Extracranial metastases | |
No | 30 (33.0) |
Yes | 61 (67.0) |
GPA score | |
Median (range) | 1.5 (0.5-3.0) |
0.5 | 15 (16.5) |
1.0-2.5 | 68 (74.7) |
3 | 8 (8.8) |
Variable | No. (%) |
---|---|
Systemic therapy (n=91) | |
No | 12 (13.2) |
Cytotoxic agent (n=49, 53.8%) | |
Docetaxel | 7 (7.7) |
Alimta | 10 (11.0) |
Gemcitabine | 1 (1.1) |
Docetaxel/Platinum | 3 (3.3) |
Alimta/Platinum | 13 (14.3) |
Gemcitabine/Platinum | 13 (14.3) |
Others | 2 (2.2) |
Targeted agent (n=30, 33.0%) | |
EGFR inhibitor | 25 (27.5) |
ALK inhibitor | 5 (5.5) |
Lines of systemic therapy (n=91) | |
None | 12 (13.2) |
1st | 39 (42.9) |
2nd | 25 (27.5) |
3rd | 8 (8.8) |
4th | 7 (7.7) |
Immunotherapy (n=91) | |
No | 72 (79.1) |
Yes (n=19, 20.9%) | |
Pembrolizumab | 6 (6.6) |
Nivolumab | 8 (8.8) |
Atezolizumab | 5 (5.5) |
RT type according per BM (n=222) | |
SRS | 203 (91.4) |
FSRT | 19 (8.6) |
SRS/FSRT prescription dose (BED, Gy) per BM (n=222) | |
12 Gy in 1 fx (26.4) | 1 (0.5) |
13 Gy in 1 fx (29.9) | 1 (0.5) |
15 Gy in 1 fx (37.5) | 4 (1.8) |
16 Gy in 1 fx (41.6) | 3 (1.4) |
18 Gy in 1 fx (50.4) | 45 (20.3) |
20 Gy in 1 fx (60.0) | 54 (24.3) |
22 Gy in 1 fx (70.4) | 17 (7.7) |
23 Gy in 1 fx (75.9) | 15 (6.8) |
24 Gy in 1 fx (81.6) | 49 (22.1) |
25 Gy in 1 fx (87.5) | 10 (4.5) |
28 Gy in 1 fx (106.4) | 4 (1.8) |
26 Gy in 2 fx (59.8) | 8 (3.6) |
32 Gy in 2 fx (83.2) | 1 (0.5) |
21 Gy in 3 fx (35.7) | 2 (0.9) |
24 Gy in 3 fx (43.2) | 2 (0.9) |
27 Gy in 3 fx (51.3) | 4 (1.8) |
28 Gy in 4 fx (47.6) | 1 (0.5) |
30 Gy in 4 fx (52.5) | 1 (0.5) |
Variable | Univariate analysis |
Multivariate analysis |
|||
---|---|---|---|---|---|
1-Year OS (%) | 2-Year OS (%) | p-value | Hazard ratio (95% CI) | p-value | |
Age (yr) | |||||
65-70 | 77.2 | 65.0 | 0.499 | - | - |
> 70 | 63.9 | 41.0 | - | - | |
GPA score | |||||
0.5 | 24.8 | 12.4 | < 0.001 | Ref | < 0.001 |
1.0-2.5 | 75.5 | 62.9 | 0.127 (0.047-0.344) | < 0.001 | |
3 | 87.5 | 72.9 | 0.083 (0.020-0.338) | 0.001 | |
Total BM volume (mm3) | |||||
≤ 1,300 | 72.0 | 60.4 | 0.258 | - | - |
> 1,300 | 67.4 | 51.5 | - | - | |
No. of BM | |||||
1-3 | 74.9 | 61.7 | 0.034 | Ref | 0.103 |
≥ 4 | 48.1 | 32.1 | 0.385 (0.122-1.215) | - | |
Primary controlled | |||||
Controlled | 76.7 | 64.1 | 0.335 | - | - |
No controlled | 66.7 | 52.2 | - | - | |
Systemic therapy | |||||
No | 45.5 | 22.7 | 0.004 | Ref | 0.015 |
Cytotoxic agent | 71.7 | 54.5 | 0.449 (0.179-1.131) | 0.089 | |
Targeted agent | 76.1 | 67.8 | 0.215 (0.074-0.622) | 0.005 | |
Immunotherapy | |||||
No | 69.0 | 53.2 | 0.744 | - | - |
Yes | 73.0 | 65.7 | - | - | |
BED (Gy) | |||||
< 60.0 | 70.5 | 57.5 | 0.735 | - | - |
≥ 60.0 | 68.9 | 54.6 | - | - |
Variable | Univariate analysis |
Multivariate analysis |
|||
---|---|---|---|---|---|
1-Year IFLC (%) | 2-Year IFLC (%) | p-value | Hazard ratio (95% CI) | p-value | |
Age (yr) | |||||
65-70 | 73.8 | 54.1 | 0.308 | - | - |
> 70 | 80.2 | 64.8 | - | - | |
GPA score | |||||
0.5 | 31.2 | 31.2 | 0.030 | - | - |
1.0-2.5 | 77.7 | 54.2 | - | ||
3 | 100 | 100 | - | ||
Total BM volume (mm3) | |||||
≤ 1,300 | 77.6 | 73.5 | 0.005 | Ref | 0.040 |
> 1,300 | 74.4 | 35.8 | 2.410 (1.042-5.576) | ||
No. of BM | |||||
1-3 | 79.6 | 63.8 | 0.014 | Ref | 0.022 |
≥ 4 | 55.8 | 18.6 | 2.962 (1.169-7.504) | ||
Primary controlled | |||||
Controlled | 77.0 | 57.0 | 0.890 | - | - |
No controlled | 75.2 | 57.9 | - | ||
Systemic therapy | |||||
No | 69.4 | 69.4 | 0.630 | - | - |
Cytotoxic agent | 72.4 | 51.7 | - | ||
Targeted agent | 84.5 | 67.3 | - | ||
Immunotherapy | |||||
No | 74.5 | 53.5 | 0.162 | - | - |
Yes | 80.8 | 70.7 | - | ||
BED (Gy) | |||||
< 60.0 | 68.3 | 37.7 | 0.031 | - | - |
≥ 60.0 | 84.5 | 79.3 | - |
BM, brain metastasis; GPA, graded prognostic assessment; KPS, Karnofsky performance status; SD, standard deviation.
ALK, anaplastic lymphoma kinase; BED, biological equivalent dose; BM, brain metastasis; EGFR, epidermal growth factor receptor; FSRT, fractionated stereotactic radiotherapy; fx, fraction; RT, radiotherapy; SRS, stereotactic radiosurgery.
BED, biological equivalent dose; BM, brain metastasis; CI, confidence interval; GPA, graded prognostic assessment; OS, overall survival; Ref, reference. Variables were entered into the multivariate regression model in a stepwise method if p ≤ 0.10 and were removed at any point if p > 0.10.
BED, biological equivalent dose; BM, brain metastasis; CI, confidence interval; GPA, graded prognostic assessment; IFLC, in-field local control; Ref, reference. Variables were entered into the multivariate regression model in a stepwise method if p ≤ 0.10 and were removed at any point if p > 0.10.