Recent trends of characteristics and treatments in adults with newly diagnosed brain metastases
Recent trends of characteristics and treatments in adults with newly diagnosed brain metastases
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新诊断脑转移成人患者特征和治疗的最新趋势
DOI：
10.1093/jjco/hyad026
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发表时间：
2023
影响因子：
2.4
通讯作者：
Kodaira Takeshi
中科院分区：
文献类型：
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作者：
Koide Yutaro;Nagai Naoya;Miyauchi Risei;Kitagawa Tomoki;Aoyama Takahiro;Shimizu Hidetoshi;Hashimoto Shingo;Tachibana Hiroyuki;Kodaira Takeshi
目的评价临床中脑转移患者的特征和治疗的最新趋势。方法纳入2016-2021年在单一癌症中心新诊断的所有脑转移患者。我们收集了每位患者的详细特征，并估计了符合以下标准的候选患者数量：Karnofsky性能状态≥70，突变的非小细胞肺癌、乳腺癌或黑色素瘤。脑转移治疗分类如下：(i)立体定向放射手术，（ii）立体定向放射手术和全身治疗，（iii）全脑放疗，（iv）全脑放疗和全身治疗，(v)手术，（vi）免疫检查点抑制剂或靶向治疗，（vii）细胞毒性药物和（ix）姑息治疗。从脑转移诊断到死亡或颅内进展，估计总生存期和颅内无进展生存期。结果共分析了800例脑转移患者；597例（74.6%）接受放疗，422例（52.7%）接受全身治疗。此外，250例（31.3%）患者被认为是普通临床试验的候选人。与2016年相比，后期倾向于从全脑放疗转向立体定向放疗（全脑放疗：35.7-29.1%，立体定向放疗：33.4-42.8%），从细胞毒性药物转向免疫检查点抑制剂/靶向治疗（细胞毒性药物：10.1-5.0，免疫检查点抑制剂/靶向治疗：7.8-10.9%）。全身治疗联合放射治疗的比例也有所增加（从26.4%增加到36.5%）。中位总生存期和无进展生存期分别为12.7个月和5.3个月。结论本研究揭示了脑转移患者特征的多样性，近期治疗选择的变化以及临床试验中候选药物的百分比。
ObjectiveWe aimed to evaluate recent trends in characteristics and treatments among patients with brain metastases in clinical practice.MethodsAll newly diagnosed patients with brain metastases during 2016–2021 at a single cancer center were enrolled. We collected the detailed features of each patient and estimated the number of candidates considered to meet the following criteria used in common clinical trials: Karnofsky performance status ≥ 70 and mutated non-small cell lung cancer, breast cancer or melanoma. The brain metastases treatments were classified as follows: (i) stereotactic radiosurgery, (ii) stereotactic radiosurgery and systemic therapy, (iii) whole-brain radiotherapy, (iv) whole-brain radiotherapy and systemic therapy, (v) surgery, (vi) immune checkpoint inhibitor or targeted therapy, (vii) cytotoxic agents and (ix) palliative care. Overall survival and intracranial progression-free survival were estimated from brain metastases diagnosis to death or intracranial progression.ResultsA total of 800 brain metastases patients were analyzed; 597 (74.6%) underwent radiotherapy, and 422 (52.7%) underwent systemic therapy. In addition, 250 (31.3%) patients were considered candidates for common clinical trials. Compared to 2016, the later years tended to shift from whole-brain radiotherapy to stereotactic radiosurgery (whole-brain radiotherapy: 35.7–29.1% and stereotactic radiosurgery: 33.4–42.8%) and from cytotoxic agents to immune checkpoint inhibitor/targeted therapy (cytotoxic agents: 10.1–5.0 and immune checkpoint inhibitor/targeted therapy: 7.8–10.9%). There was also an increase in the proportion of systemic therapy combined with radiation therapy (from 26.4 to 36.5%). The median overall survival and progression-free survival were 12.7 and 5.3 months, respectively.ConclusionsThis study revealed the diversity of brain metastases patient characteristics, recent changes in treatment selection and the percentage of candidates in clinical trials.