Prognostic factors for survival and radiation necrosis after stereotactic radiosurgery alone or in combination with whole brain radiation therapy for 1-3 cerebral metastases

Episode von Medizin - Open Access LMU - Teil 22/22 von Ludwig-Maximilians-Universität München · 1. Januar 2014

Background: In the present study factors affecting survival and toxicity in cerebral metastasized patients treated with stereotactic radiosurgery (SRS) were analyzed with special focus on radiation necrosis. Patients and methods: 340 patients with 1-3 cerebral metastases having been treated with SRS were retrospectively analyzed. Radiation necrosis was diagnosed by MRI und PET imaging. Univariate and multivariate analysis using a Cox proportional hazards regression model and log-rank test were performed to determine the prognostic value of treatment-related and individual factors for outcome and SRS-related complications. Results: Median overall survival was 282 days and median follow-up 721 days. 44% of patients received WBRT during the course of disease. Concerning univariate analysis a significant difference in overall survival was found for Karnofsky Performance Status (KPS 2.5 ml: 234 days), prescribed dose ( 18 Gy: 351 days), gender (male: 235 days; female: 327 days) and whole brain radiotherapy (+ WBRT: 341 days/-WBRT: 231 days). In multivariate analysis significance was confirmed for KPS, RPA class and gender. MRI and clinical symptoms suggested radiation necrosis in 21 patients after SRS +/-whole brain radiotherapy (WBRT). In five patients clinically relevant radiation necrosis was confirmed by PET imaging. Conclusions: SRS alone or in combination with WBRT represents a feasible option as initial treatment for patients with brain metastases; however a significant subset of patients may develop neurological complications. Performance status, RPA class and gender were identified to predict improved survival in cerebral metastasized patients.

Weitere Episoden von „Medizin - Open Access LMU - Teil 22/22“

• A cross-sectional analysis of the effects of residential greenness on blood pressure in 10-year old children: results from the GINIplus and LISAplus studies 1. Januar 2014
• A large kindred of pulmonary fibrosis associated with a novel ABCA3 gene variant 1. Januar 2014
• A randomised multicentre trial of acupuncture in patients with seasonal allergic rhinitis - trial intervention including physician and treatment characteristics 1. Januar 2014
• Association between anemia and falls in community-dwelling older people: cross-sectional results from the KORA-Age study 1. Januar 2014
• Biological health or lived health: which predicts self-reported general health better? 1. Januar 2014
• Circulating cell-free methylated DNA and lactate dehydrogenase release in colorectal cancer 1. Januar 2014
• Comparative cost-effectiveness analyses of cardiovascular magnetic resonance and coronary angiography combined with fractional flow reserve for the diagnosis of coronary artery disease 1. Januar 2014
• Comprehensive analysis of beta-catenin target genes in colorectal carcinoma cell lines with deregulated Wnt/beta-catenin signaling 1. Januar 2014
• Contribution of socioeconomic status, stature and birth weight to obesity in Sub-Saharan Africa: cross-sectional data from primary school-age children in Cameroon 1. Januar 2014
• Early versus later response to treatment in patients with community-acquired pneumonia: analysis of the REACH study 1. Januar 2014
• Evidence-based decision-making in infectious diseases epidemiology, prevention and control: matching research questions to study designs and quality appraisal tools 1. Januar 2014
• Evidence for significant influence of host immunity on changes in differential blood count during malaria 1. Januar 2014
• Experience of gratitude, awe and beauty in life among patients with multiple sclerosis and psychiatric disorders 1. Januar 2014
• Exploring patterns of accelerometry-assessed physical activity in elderly people 1. Januar 2014
• A comprehensive analysis of Helicobacter pylori plasticity zones reveals that they are integrating conjugative elements with intermediate integration specificity 1. Januar 2014

Alle Episoden von Medizin - Open Access LMU - Teil 22/22 · Mehr Bildung-Podcasts