The Choice of Local Treatment Modalities for Patients with Brain Metastases from Digestive Cancers

Jun Dong; Liyan Wu; Fang Wang; Jinsheng Huang; Pili Hu; Bei Zhang; Liang-Ping Xia

doi:10.1155/2019/1568465

The Choice of Local Treatment Modalities for Patients with Brain Metastases from Digestive Cancers

J Oncol. 2019 Nov 21:2019:1568465. doi: 10.1155/2019/1568465. eCollection 2019.

Authors

Jun Dong¹, Liyan Wu², Fang Wang³, Jinsheng Huang¹, Pili Hu¹, Bei Zhang¹, Liang-Ping Xia¹

Affiliations

¹ Department of Intergrated Therapy in Oncology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, No. 651, East Dong Feng Road, Guangzhou, Guangdong 510060, China.
² Department of Clinical Medicine, Sun Yat-Sen University, No. 74, Zhong Shan Er Lu, Guangzhou, Guangdong 510060, China.
³ Department of Oncology, The First Affiliated Hospital of Sun Yat-Sen University, No. 58, Zhong Shan Er Lu, Guangzhou, Guangdong 510060, China.

Abstract

Background: Brain metastases (BMs) from digestive cancers are rare; therefore, no optimal treatment modality has been defined.

Methods: We retrospectively reviewed the clinical data of 68257 patients with digestive cancers. Propensity score matching (PSM) was used to balance patient backgrounds between groups. Survival differences between different treatment modalities were compared. Univariate and multivariate Cox proportional hazards models were performed to identify prognostic factors on overall survival (OS).

Results: 270 patients with BM entered the study. In the entire group, the median survival time after diagnosis of brain metastases was 10.25 months (95% CI: 8.41-12.09 months); local treatment could significantly prolong OS (respectively, P < 0.01; even after PSM, P < 0.01); combination treatment was more effective than single treatment modality (respectively, P < 0.01; even after PSM, P < 0.01). However, each combination modality was identically effective (P > 0.05). When patients were divided into three groups based on 1, 2-3, or more than 3 metastatic lesion(s), same results were identified between local treatment and without local treatment (1 lesion, P < 0.01; 2-3 lesions, P < 0.01; more than 3 lesions, P < 0.01, respectively) and combination and single treatment (P < 0.01, P=0.02, P=0.03, respectively). However, there was no difference between different combined treatments (P > 0.05). Multivariate analysis revealed that performance status (P < 0.01), presence of extracranial metastasis (P=0.04), number of BM (P < 0.01), and local treatment for BM (P < 0.01) were independent prognostic factors.

Conclusions: Regardless of the number of brain lesions, local treatment achieved higher overall survival times than no local treatment, and combination therapy could offer survival benefit to patients as compared with single therapy.