title: Prognostic factors in patients with brain metastasis from non-small cell lung cancer treated with whole-brain radiotherapy.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the prognostic factors associated with overall survival (OS) in nonsmall cell lung cancer (NSCLC) patients with brain metastasis who received whole-brain radiotherapy (WBRT).
  
  
  METHODS
  This study included 264 consecutive NSCLC patients with brain metastasis who received WBRT. Patients with leptomeningeal metastasis and those who underwent craniotomy or stereotactic radiotherapy before WBRT were excluded. The evaluated prognostic factors for OS included gender, neurological deficit, histology, epidermal growth factor receptor (EGFR) mutation status, previous cytotoxic chemotherapy, previous EGFR-tyrosine kinase inhibitor treatment, recursive partitioning analysis (RPA) class, and diagnosis-specific graded prognostic assessment (DS-GPA) score. All factors with a P < 0.05 in univariate analysis were entered into multivariate analysis using Cox regression and a confidence interval of 99%.
  
  
  RESULTS
  Two hundred thirty patients had died, 14 patients were alive, and 20 patients were lost to follow-up. The median follow-up time was 20.9 months. The median survival time was 5.5 months (95% confidence interval; 4.8-6.3). Univariate analysis showed that gender, neurological deficit, histology, EGFR mutation status, RPA class, and DS-GPA score were significant prognostic factors for OS. In multivariate analysis, RPA class and histology were found to be significant prognostic factors for OS, with P values of 0.0039 and 0.0014, respectively.
  
  
  CONCLUSIONS
  RPA Class I or II (Karnofsky Performance Status ≥70) and adenocarcinoma histology were associated with longer OS. These factors should be taken into account when considering indication for WBRT.
authors.affiliation: Division of Radiation Oncology, Shizuoka Cancer Center, Nagaizumi-cho, Sunto-gun, Shizuoka, Japan.
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Harada
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Asakura
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Ogawa
authors.forename: Keita
authors.initials: K
authors.lastname: Mori
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Takahashi
authors.forename: Yoko
authors.initials: Y
authors.lastname: Nakasu
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Nishimura
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000532:radiotherapy*; D000368:Aged; D001921:Brain / Q000473:pathology / Q000528:radiation effects*; D001932:Brain Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000532:radiotherapy*; D016371:Cranial Irradiation; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D016896:Treatment Outcome