Survival and effective prognostic factors in lung cancer patients with brain metastases treated with whole brain radiotherapy

Objective:To evaluate the outcomes and explore the risk factors for survival of lung cancer patients with brain metastases(BMs)who were treated with whole brain radiotherapy(WBRT)and to identify the significance of the risk factors.Methods:A retrospective analysis was carried out for lung cancer patients with BMs who were treated with WBRT in the Second Affiliated Hospital of Soochow University from January 2014 to December 2017.Their survival time was calculated using the Kaplan-Meier method.Meanwhile,the neutrophil-lymphocyte ratio(NLR)cutoff values were defined using the receiver operating characteristic(ROC)curve analysis,and the characteristics of different NLR groups were compared using the Wilcoxon Rank Sum Test.Results:A total of 179 patients were assessed.Their median overall survival(OS)was 9.9(95%CI 7.08–12.72)months.As shown by univariate analyses,their OS was significantly affected by histology(P<0.001),number of BMs(P=0.009),local treatment of BMs(P=0.019),Karnofsky Performance Status score(P=0.001),Graded Prognostic Assessment(GPA)score(P<0.001),hemoglobin level(P=0.002),lymphocyte count(P=0.006),albumin level(P=0.001),and NLR(P<0.001).Meanwhile,according to multivariate analyses,independent risk factors for OS included non-adenocarcinoma(ADCA)histology(P<0.001)and high NLR(P=0.006).Moreover,the optimal NLR cutoff value was determined to be 7.0.The patients in this study were divided into three categories based on their total score determined by assigning each risk factor of histology and NLR one point.The median survival in the patients with scores of 0,1,and 2 was 19.6 months,8.5 months,and 2.2 months,respectively(P=0.001).The survival time and prognostic factors of different pathological types of patients were further analyzed.As a result,the median OS of patients with small-cell lung cancer(SCLC),ADCA patients receiving targeted therapy,and ADCA patients not receiving targeted therapy was 10.9 months,13.2 months,and 9.5 months,respectively.The results of multivariate analyses all showed that NLR was an independent risk factor for OS of these three pathological types of patients.Conclusions:Non-ADCA histology and high NLR serve as independent prognostic factors for survival of lung cancer patients with BMs who have been treated with WBRT.A prognostic model comprising histological type and NLR can be used to evaluate the survival.

High-dose methotrexate and zanubrutinib combination therapy for primary central nervous system lymphoma

In this editorial I comment on the article,published in the current issue of the World Journal of Clinical Oncology.Primary central nervous system lymphoma(PCNSL)is a disease of elderly and immunocompromised patients.The authors reported clinical results of 19 patients with PCNSL treated with zanubrutinib/high dose methotrexate(HD-MTX)until disease progression.They demonstrated that the combination of zanubrutinib with HD-MTX led to a marked clinical response and tolerability among these patients.They also observed that cerebrospinal fluid liquid biopsy to detect circulating tumor DNA may be a good option for evaluating treatment response and tumor burden in patients with PCNSL.PCNSL is a challenging disease for treatment as these patients present with different neurological states and comorbidities.Treatment has evolved over the years from whole brain radiotherapy to HD-MTX followed by autologous stem cell transplant.Gradually,treatment of patients with PCNSL is going to become individualized.

Choriocarcinoma misdiagnosed as cerebral hemangioma:A case report

BACKGROUND Choriocarcinoma is a subtype of gestational trophoblastic disease,gestational trophoblastic neoplasia.Patients with brain metastasis are rare and information on the optimal treatment and patient outcome is limited.In order to improve the prognosis of this disease,accurate and timely treatments are very important for the patient of brain metastasis by choriocarcinoma.CASE SUMMARY A 17-year-old unmarried girl was misdiagnosed with a cerebral hemangioma with intracranial hemorrhage in a local hospital after presentation with severe head pain.She underwent craniotomy three times for treatment.The pathological results of posterior intracranial hematoma showed choriocarcinoma,and the patient was diagnosed as choriocarcinoma(21 points in stage IV).After uterine artery embolization,etoposide,methotrexate,actinomycin D,cyclophosphamide,and vincristine chemotherapy for 7 cycles,and whole brain radiotherapy,the patient achieved remission.She has been followed for 2 years with no signs of tumor recurrence.CONCLUSION For female patients of childbearing age with an intracranial hematoma,the possibility of brain metastasis by choriocarcinoma should be considered.It is necessary to obtain a detailed history,including menstruation,beginning age of first sex,contraception,etc.The level ofβ-human chorionic gonadotropin should be tested at the beginning,and a stratified treatment should be administered according to the International Federation of Gynecology and Obstetrics staging and World Health Organization prognostic scoring systems.

Brain metastasis treated with Cyberknife

Background Cyberknife can greatly raise the fractional dose of stereotactic radiosurgery, thus improving its clinical efficacy. We retrospectively analyzed clinical outcomes of brain metastasis treated with Cyberknife. Methods We analyzed 40 cases of brain metastases treated with Cyberknife in the Tianjin Cancer Hospital from August 1, 2006 to August 1, 2007, for a total of 68 lesions with maximal diameter of 0.4-7.5 cm （average 1.88 cm）. Total hypofractional radiated dosage was 18-36 Gy （5-25 Gy/F, 1-5 F） by Cyberknife. We evaluated the remission rate of clinical symptoms, correlation factors to new foci, 3-month local control rates, and 3-month and 1-year survival rates. All patients were followed up for more than 14 months. Results After 1 week, clinical remission was 90.0% （36/40）. After 3 months, the local control rate and therapeutic effective rate were 77.9% （53/68） and 94.1% （64/68）, respectively, as observed by cranium augmentation CT or MRI. The three-month, six-month and 1-year survival rates were 97.5% （39/40）, 82.5% （33/40） and 67.5% （27/40）, respectively. Fourteen patients had neopathy outside the original lesion after 3 months. Neopathy was not correlated with age, whole-brain radiotherapy, number of original lesions, maximum diameter of the original lesion, therapeutic dose per fraction, therapeutic frequency or total therapeutic dose. Conclusions Cyberknife got perfect clinical outcomes by higher dosage per fraction. It is an appropriate and valid treatment shortcut for brain metastasis.