title: A cure is possible: a study of 10-year survivors of brain metastases.
abstract: Little is known on the natural history, recurrence patterns, neurocognitive outcomes and prognostic factors associated with survival in long-term survivors (≥10 years) from brain metastasis (BM). In this study, the records of 1953 patients who underwent treatment for BM with a potential for ≥10 years of follow-up were reviewed. Cox regression analysis identified factors predictive for overall survival (OS). The median age at brain metastasis diagnosis was 60 years and the median OS was 6.4 months. The 1-year OS rate was 29.9, 12.1 % at 2 years, 3.0 % at 5 years, and 1.3 % at 10 years. On multivariable analysis, factors associated with worse OS included gender (males, HR 1.2), multiple brain metastases (HR 1.3), no surgery (HR 1.8), and no stereotactic radiosurgery (HR 1.8) (p < 0.0001 each). Fifty-six patients (2.9 %) survived ≥5 years; 23 patients (1.2 %) survived ≥10 years and the median survival for ≥10 year survivors was 18.5 years. Six of the 10-year survivors had an intracranial recurrence, five occurred within 11 years from the first treatment. Presence of a solitary lesion or single lesion at the time of brain metastasis diagnosis was associated with improved survival. Eight of the ≥10 year survivors (34.8 %) had no neurological symptoms at last follow-up; none of the 10-year survivors were documented to have a neurologic death. Our study demonstrates that patients with favorable prognostic features should undergo multimodality treatment. Albeit rare, patients who are alive 10 years after treatment for their brain metastases may be considered cured from their intracranial disease.
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Rupesh
authors.initials: R
authors.lastname: Kotecha
authors.affiliation: Department of Psychiatry and Psychology, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Sally
authors.initials: S
authors.lastname: Vogel
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.|Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland, OH, 44195, USA.
authors.forename: John H
authors.initials: JH
authors.lastname: Suh
authors.affiliation: Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland, OH, 44195, USA.|Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Gene H
authors.initials: GH
authors.lastname: Barnett
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.|Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland, OH, 44195, USA.
authors.forename: Erin S
authors.initials: ES
authors.lastname: Murphy
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Chandana A
authors.initials: CA
authors.lastname: Reddy
authors.affiliation: Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland, OH, 44195, USA.|Center for Behavioral Health, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Parsons
authors.affiliation: Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland, OH, 44195, USA.|Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Vogelbaum
authors.affiliation: Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland, OH, 44195, USA.|Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Lilyana
authors.initials: L
authors.lastname: Angelov
authors.affiliation: Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland, OH, 44195, USA.|Department of Neurosurgery, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Alireza M
authors.initials: AM
authors.lastname: Mohammadi
authors.affiliation: Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland, OH, 44195, USA.|Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Glen H J
authors.initials: GHJ
authors.lastname: Stevens
authors.affiliation: Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland, OH, 44195, USA.|Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Peereboom
authors.affiliation: Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland, OH, 44195, USA.|Department of Hematology/Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA.
authors.forename: Manmeet S
authors.initials: MS
authors.lastname: Ahluwalia
authors.affiliation: Department of Radiation Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, USA. chaos@ccf.org.|Rose Ella Burkhardt Brain Tumor and Neuro-Oncology Center, Cleveland, OH, 44195, USA. chaos@ccf.org.
authors.forename: Samuel T
authors.initials: ST
authors.lastname: Chao
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001932:Brain Neoplasms / Q000401:mortality* / Q000556:secondary / Q000628:therapy*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D016634:Radiosurgery / Q000379:methods*; D015996:Survival Rate; D013997:Time Factors
keywords: Brain metastasis; Long-term; Neurocognitive; Stereotactic radiosurgery; Surgery; Survivors; Whole-brain radiation therapy