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Long-term survival in patients with brain metastases
Johannes Lutterbach1, Susanne Bartelt, Christoph Ostertag
1Radiologische Universitätsklinik, Abteilung Strahlenheilkunde, Hugstetter Strasse 55, 79106 Freiburg, Germany. lutterba@mst1.ukl.uni-freiburg.de
Purpose:
The aims of this study are: (a) to determine long-term survival in patients with brain metastases who underwent whole brain radiation therapy; (b) to evaluate whether long-term survival can be predicted by the Radiation Therapy Oncology Group (RTOG) recursive partitioning analysis (RPA); and (c) to review the literature on long-term survival.
Material And Methods:
The records of 916 patients with brain metastases who underwent whole brain radiation therapy at our hospital from 1985 to 2000 were analyzed retrospectively.
Results:
By July 2001, 891 patients had died. Median survival of the whole group was 3.4 months. Overall survival was 5.6% at 2 years (at risk: n=48), 2.9% at 3 years ( n=25), 1.8% at 5 years ( n=12), and <1% at 10 years ( n=1). Survival for 2 years or more was observed in RTOG RPA class 1, but also in class 2 patients. Within both classes, survival was significantly better for patients with a single brain metastasis compared with those patients having multiple metastases. A survey of the literature revealed that in rare instances survival of 10 years or more was seen in patients with brain metastases. The majority of these patients had a single brain metastasis treated by radical resection and whole brain radiation therapy.
Conclusion:
Even in patients with favorable characteristics, survival for 2 years or more after the diagnosis of brain metastases is considerably low. Aggressive therapy in RPA class 1 and class 2 patients with a single brain metastasis occasionally permits long-term survival.