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PV QA 2 - Poster Viewing Q&A 2

MO_9_2736 - Survival and Prognostic Factors in Patients with Gastrointestinal Cancers and Brain Metastases

Monday, October 22
10:45 AM - 12:15 PM
Location: Innovation Hub, Exhibit Hall 3

Survival and Prognostic Factors in Patients with Gastrointestinal Cancers and Brain Metastases
P. W. Sperduto1, P. Fang Sr2, J. Li3, W. Breen4, P. D. Brown3, D. N. Cagney5, S. D. Myrehaug6, S. Jain7, B. Cameron8, J. K. Molitoris9, C. C. Wu10, N. A. Lockney11, J. R. Parkhurst12, R. Shanley13, D. J. Tandberg14, D. D. Shi15, M. D. Chuong16, H. Saito17, L. Masucci18, and M. P. Mehta19; 1Gamma Knife Center, University of Minnesota Medical Center, Minneapolis, MN, 2The University of Texas MD Anderson Cancer Center, Houston, TX, 3Dept. of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 4Mayo Clinic, Rochester, MN, 5Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA, 6Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada, 7University of Colorado Denver, Denver, CO, 8Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, TN, 9University of Maryland Medical Center, Baltimore, MD, 10Department of Radiation Oncology, Columbia University Medical Center, New York, NY, 11Memorial Sloan Kettering Cancer Center, New York, NY, 12Department of Radiation Oncology, University of Iowa Hospitals and Clinics, Iowa City, IA, 13University of Minnesota Biostatistics, Minneapolis, MN, 14Duke University Medical Center, Durham, NC, 15Massachusetts General Hospital, Boston, MA, 16University of Maryland School of Medicine, Baltimore, MD, 17Department of Radiology and Radiation Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan, 18Centre Hospitier de l'université de Montreal, Montreal, QC, 19Miami Cancer Institute, Baptist Health South Florida, Miami, FL

Purpose/Objective(s): Literature is sparse regarding the prognosis of patients with gastrointestinal (GI) cancers and brain metastases (BM). Our group previously published a prognostic index, the Graded Prognostic Assessment (GPA) for GI cancer patients with BM, based on 209 patients diagnosed from 1985-2005. The purpose of this analysis is to identify prognostic factors for GI cancer patients with newly diagnosed BM in a larger contemporary cohort.

Materials/Methods: A multi-institutional (16) retrospective IRB-approved database of 685 GI cancer patients with new BM diagnosed from 1/1/2006-12/31/2016 was created using REDCap. Demographic data, clinical parameters and treatment were correlated with survival, time from primary diagnosis to BM (TPDBM) and cause of death. Kaplan-Meier median survival estimates were calculated and compared with log-rank tests.

Results: The median survival (MS) from time of first treatment for BM for the prior and current cohorts were 5 and 7 months, respectively (p<0.001). Eight prognostic factors (GI GPA, age, stage, KPS, extracranial metastases (ECM), number of BM, primary site and Hgb at the time of BM diagnosis) were found to be statistically significant for survival, in contrast to only one (KPS) in the prior cohort. MS (mo) by primary site were: stomach (2), transverse colon (2), pancreas (4), GE junction (4), Gallbladder (5), Left and right colon (7), rectum (7), esophagus (9), small bowel (9), rectosigmoid (10) and anus (14). Median TPDBM was 22 months. Shorter TPDBM was seen with esophageal, gastroesophageal junction, gastric cancers. The cause of death was known in 54% (370/685) and among those, neurologic only death occurred in 25% (92/370). Nearly one third of patients (219/685) presented with poor prognosis (GPA 0-1.0).  

Factor

Range

N

OS (mo)

p-value

Overall

1985-2005 / 2006-2016

209 / 685

5 / 7

<0.001

GPA

0-1 / 1.5-2 / 2.5-3 / 3.5-4.0

219 / 179 / 177 / 39

4 / 6 / 11 / 14

<0.001

KPS

<70 / 70 / 80 / 90 / 100

95 / 124 / 179 / 177 / 39

3 / 4 / 6 / 11 / 14

<0.001

# Brain Mets

1 / 2-3 / >3

337 / 204 / 137

10 / 7 / 3

<0.001

Hgb

< 11 / 11-12.5 / 12.6-14 / > 14

113 /110 / 118 / 116

3 /6 / 7 / 11

<0.001

Age

25-52 / 53-61 / 62-68 / > 68

166 / 163 / 190 / 166

10 / 8 / 7 / 5

0.002

Stage

I / II / III / IV / unknown

27 / 79 / 221 / 294 / 64

7 / 11 / 9 / 6 / 7

0.004

HER2

negative / positive / unknown

82 / 48 / 555

5 / 11 / 7

0.06

Conclusion: OS has improved slightly in recent decades and varies by primary site. In stark contrast to our studies of patients with lung, melanoma, breast and renal cell cancers, a much higher percentage (32%) of GI patients with BM present with poor prognosis (GPA 0-1.0), highlighting the need for earlier diagnosis and better treatment. More prognostic factors have been identified. The impact of HER2/KRAS/EGFR/BRAF on OS by primary site will be presented. These data will be useful in counseling patients, refining clinical decision-making and the GI-GPA index and stratification of future clinical trials.  

Author Disclosure: P.W. Sperduto: Independent Contractor; Univ. of Minnesota. Partnership; Minneapolis Radiation Oncology, PA. Co-Director; University of Minnesota Gamma Knife Center. P. Fang: None. J. Li: Research Grant; BMS, Medtronic. Travel Expenses; Elekta. W. Breen: None. P.D. Brown: None. D.N. Cagney: None. S.D. Myrehaug: None. J.K. Molitoris: None. C. Wu: None. N.A. Lockney: None. M.P. Mehta: Consultant; Agenus, Insys, Remedy, IBA, Oncoceutics, Astra-Zeneca, Monteris. CNS Committee Chair; NRG Oncology. Board of Directors; PCG.

William Breen, MD

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