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Objective We aimed to evaluate recent trends in characteristics and treatments among patients with brain metastases in clinical practice. Methods All newly diagnosed patients with brain metastases during 2016–2021 at a single cancer center were enrolled. We collected the detailed features of each patient and estimated the number of candidates considered to meet the following criteria used in common clinical trials: Karnofsky performance status ≥ 70 and mutated non-small cell lung cancer, breast cancer or melanoma. The brain metastases treatments were classified as follows: (i) stereotactic radiosurgery, (ii) stereotactic radiosurgery and systemic therapy, (iii) whole-brain radiotherapy, (iv) whole-brain radiotherapy and systemic therapy, (v) surgery, (vi) immune checkpoint inhibitor or targeted therapy, (vii) cytotoxic agents and (ix) palliative care. Overall survival and intracranial progression-free survival were estimated from brain metastases diagnosis to death or intracranial progression. Results A total of 800 brain metastases patients were analyzed; 597 (74.6%) underwent radiotherapy, and 422 (52.7%) underwent systemic therapy. In addition, 250 (31.3%) patients were considered candidates for common clinical trials. Compared to 2016, the later years tended to shift from whole-brain radiotherapy to stereotactic radiosurgery (whole-brain radiotherapy: 35.7–29.1% and stereotactic radiosurgery: 33.4–42.8%) and from cytotoxic agents to immune checkpoint inhibitor/targeted therapy (cytotoxic agents: 10.1–5.0 and immune checkpoint inhibitor/targeted therapy: 7.8–10.9%). There was also an increase in the proportion of systemic therapy combined with radiation therapy (from 26.4 to 36.5%). The median overall survival and progression-free survival were 12.7 and 5.3 months, respectively. Conclusions This study revealed the diversity of brain metastases patient characteristics, recent changes in treatment selection and the percentage of candidates in clinical trials.

This study aimed to evaluate the clinical benefits of systemic therapy (ST) combined with stereotactic radiosurgery (SRS) for brain metastases (BM).The patient data were extracted from the institutional disease database from 2016 to 2021. Surgical and whole-brain radiotherapy cases and poor Karnofsky performance status (KPS 70) were excluded. The eligible patients were divided into monotherapy (SRS alone or ST alone) and combined therapy (SRS and ST, combined within a month). Univariate and multivariate Cox proportional hazards analyses were used to examine factors associated with increased risk of death and intracranial progression. The propensity score for selecting treatment was calculated based on existing prognostic covariates. Two groups were matched 1:1 and compared for intracranial progression-free survival (PFS) and overall survival (OS).We identified 1605 patients and analyzed 928 (monotherapy: n = 494, combined therapy: n = 434). In a multivariable model, the combined therapy was independently associated with improved PFS and OS relative to the monotherapy. At the median follow-up of 383 days in the matched dataset, the combined therapy group showed significantly longer PFS (median, 7.4 vs. 5.0 months, P 0.001) and OS (median, 23.1 vs. 17.2 months, P = 0.036) than the monotherapy group. The overall intracranial progression and mortality risk was reduced in the combined therapy group, with an estimated HR of 0.70 and 0.78.Combined therapy exhibited longer PFS and OS than monotherapy in BM patients. The results support the recent trend toward combining systemic and local therapies, encouraging future clinical trials.

To establish a predictive model for pain response following radiotherapy using a combination of radiomic and clinical features of spinal metastasis. This retrospective study enrolled patients with painful spine metastases who received palliative radiation therapy from 2018 to 2019. Pain response was defined using the International Consensus Criteria. The clinical and radiomic features were extracted from medical records and pre-treatment CT images. Feature selection was performed and a random forests ensemble learning method was used to build a predictive model. Area under the curve (AUC) was used as a predictive performance metric. 69 patients were enrolled with 48 patients showing a response. Random forest models built on the radiomic, clinical, and ‘combined’ features achieved an AUC of 0.824, 0.702, 0.848, respectively. The sensitivity and specificity of the combined features model were 85.4% and 76.2%, at the best diagnostic decision point. We built a pain response model in patients with spinal metastases using a combination of clinical and radiomic features. To the best of our knowledge, we are the first to examine pain response using pre-treatment CT radiomic features. Our model showed the potential to predict patients who respond to radiation therapy.

Deep-inspiration breath-hold radiotherapy (DIBH-RT) to reduce the cardiac dose irradiation is widely used but some patients experience little or no reduction. We constructed and compared two prediction models to evaluate the usefulness of our new synthetic DIBH-CT (sCT) model. Ninety-four left-sided breast cancer patients (training cohort: n = 64, test cohort: n = 30) underwent both free-breathing and DIBH planning. The U-Net-based sCT generation model was developed to create the sCT treatment plan. A linear prediction model was constructed for comparison by selecting anatomical predictors of past literature. The primary prediction outcome is the mean heart dose (MHD) reduction, and the coefficient of determination (R2), root mean square error (RMSE) and mean absolute error (MAE) were calculated. Moreover, we evaluated the heart and lungs contours’ similarity and Hounsfield unit (HU) difference between both images. The median MHD reduction was 1.14 Gy in DIBH plans and 1.09 Gy in sCT plans (P = 0.96). The sCT model achieved better performance than the linear model (R2: 0.972 vs 0.450, RMSE: 0.120 vs 0.551, MAE: 0.087 vs 0.412). The organ contours were similar between DIBH-CT and sCT: the median Dice (DSC) and Jaccard similarity coefficients (JSC) were 0.912 and 0.838 for the heart and 0.910 and 0.834 for the lungs. The HU difference in the soft-tissue region was smaller than in the air or bone. In conclusion, our new model can generate the affected CT by breath-holding, resulting in high performance and well-visualized prediction, which may have many potential uses in radiation oncology.

Background: Deep inspiration breath-hold (DIBH) radiotherapy is effective but requires specific devices for tracking the respiratory cycle or surface motion. There are some reports of DIBH without such devices. However, to the best of our knowledge, no study has evaluated all three components which are: setup accuracy, dose assessment, and treatment time. We evaluated the accuracy, effect of dose reduction on organs at risk (OARs), and the treatment time of our DIBH technique, which avoids the use of such devices.Methods: We analyzed 64 left-sided early breast cancer patients. Three-dimensional conformal radiotherapy treatment plans of 42.56 Gy in 16 fractions were created in free-breathing (FB) and DIBH settings. Thirty patients were evaluated for inter- and intra-fractional displacement. The treatment room entry-to-exit times were measured and retrospectively compared with those of 44 right breast cancer patients who received FB radiotherapy (Right-FB) in the same period. The volumes and dose metrics of the clinical target volume (CTV) and contoured OARs (HEART, left anterior descending artery [LAD], and LUNG) were compared between FB and DIBH.Results: The average inter-fractional, intra-fractional, and overall setup displacement were 2.32 ± 1.30, 0.55 ± 0.43, and 2.46 ± 1.24 mm, respectively. Compared to Right-FB, the medians of entry-to-exit times slightly increased in DIBH (9 vs 7 minutes, P = 3.95e-23). The LUNG volume in DIBH was 1.58 times larger than that in FB, but other volumes were not statistically different. Compared to FB, the median HEART, LAD, and mean LUNG doses decreased significantly in DIBH: 1.67 vs 0.71 (P = 9.72e-15), 13.0 vs 2.3 (P = 6.65e-15), and 2.42 vs 2.03 (P = 6.80e-8) Gy, respectively. CTV doses were not statistically different.Conclusions: With only minor setup errors, this simple and cost-effective DIBH technique is a feasible method. It can be easily tested for new facilities and is expected to accelerate the further clinical implementation.Trial registration