Introduction The 19th Annual Meeting of the Society for Neuro-Oncology (SNO) took place in November of 2014. The focus of many abstracts, as well as the Education Day, was on recent advances in the study of central nervous system (CNS) metastases. Tumor biology Key studies evaluating the factors in tumors and their microenvironment associated with the development and growth of brain metastases are reviewed. Prognostication Studies investigating the factors that independently influence survival in participants with brain metastases are presented. Response assessment The Response Assessment for Neuro-Oncology criteria for brain metastases (RANO-BM) and the Neurological Assessment in Neuro-Oncology (NANO) criteria, which were both presented, are recapped. Radiotherapy Studies are reviewed evaluating factors that influence survival outcomes in participants with brain metastases who were treated with radiotherapy. Studies investigating the potential risk of radiation necrosis with the combination of radiotherapy and immunotherapies are presented. Systemic therapies Brain metastases-focused subset analyses from the ASCEND-1 trial for ALK-translocated non-small cell lung cancer are presented. Preclinical and clinical work on solid tumor leptomeningeal carcinomatosis is also covered. Sequelae of central nervous system metastases and their treatments An overview is provided of treatment- related toxicities as well as important concepts that may influence strategies to protect against these toxicities. Conclusions Key concepts regarding tumor biology, prognostication, response assessment, therapeutic management, and sequelae of treatment for CNS metastases are summarized. Advances in our understanding of the basic and clinical science of CNS metastases have the potential to improve outcomes for patients.

/pdf/society-for-neuro-oncology-2014-annual-meeting-updates-on-391g26sr4r.pdf

Society for Neuro-Oncology 2014 annual meeting updates on central nervous system metastases

INTRODUCTION: Defining key prognostic factors for patients with cerebral metastases who underwent stereotactic radiosurgery (SRS) treatment will greatly facilitate future clinical trial designs. However, these is little agreement in terms of these prognostic factors in the existing literature. METHODS: We adopted a two-phase study design where results from one cohort were validated in a second independent cohort. The exploratory analysis reviewed the survival outcomes of 1017 consecutive patients (with 3610 metastases) who underwent Gamma radiosurgery at the University of California, San Diego (UCSD)/San Diego Gamma Knife Center (SDGKC). Multivariate analysis was performed to identify prognostic factors. Results were validated using data derived from 2253 consecutive patients (with 17,539 metastases) treated with SRS at the Tokyo Women's Medical University (TWMU). RESULTS: For the SDGKC cohort, the median overall survival of patients following SRS was 7 months. Two year follow-up data was available for 85 % of the patients. Multivariable analysis found that patient age, Karnofsky performance score, systemic cancer status, tumor histology, number of metastasis, and cumulative tumor volume independently associated with overall survival (p < 0.001). All statistical associations were validated in multivariate analysis of data derived from the TWMU cohort. CONCLUSIONS: This is the first large scale study that defined prognostic factors for SRS treated patients with cerebral metastasis using an inter-institutional validation study design. The work establishes a model for collaborative interactions between large volume centers and provides prognostic variables that should be incorporated into future clinical trial design.

/pdf/bm-08prognostic-factors-for-srs-treated-patients-with-3af3y2cti1.pdf

Bm-08prognostic factors for srs-treated patients with cerebral metastasis: implications on randomized control trial design and inter-institutional collaborative efforts

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Bm-08prognostic factors for srs-treated patients with cerebral metastasis: implications on randomized control trial design and inter-institutional collaborative efforts