Treatment trends in brain metastases from testicular cancer in the United States

Abstract

Aim: We utilized the National Cancer Database to describe the treatment trends in brain metastases from primary testicular cancers. Methods: We analyzed data from the NCDB from 2010 to 2015 for patients with both primary testicular cancers and brain metastases who were treated with brain-directed radiation. We performed multivariable logistic and cox regressions to identify predictors of treatment type and overall survival respectively. Results: Most patients meeting the above criteria received whole brain radiation therapy as opposed to stereotactic radiosurgery (SRS). Predictors of improved survival were age, private insurance coverage, receipt of chemotherapy, and receipt of SRS. The 5-year survival rate was highest for patients who received SRS. Conclusion: This study confirms significantly improved overall survival with the use of SRS.

Plain language summary

Testicular cancer is quite rare, making up just 1% of solid cancers found in men every year. Even rarer is the situation where this cancer spreads to the brain. When this happens, it can be treated in a few different ways: surgery, radiation to the entire brain, a focused type of radiation called stereotactic radiosurgery, or a combination of these methods. Due to its rarity, there isn’t a clear-cut best approach for treating these brain tumors. In our research, we used a massive database, the National Cancer Database (NCDB), to get a clearer picture of this issue. We looked at patients diagnosed with testicular cancer between 2004 and 2015 who also had at least one tumor in the brain. By analyzing this information, we could compare the survival outcomes of patients based on the type of treatment they received and other factors.

We found that brain tumors from testicular cancer are very rare, found in just 0.4% of the patients we studied. We also found that treatment with either focused radiation, whole brain radiation, or chemotherapy significantly improves survival rates compared with no treatment. In addition, focused radiation, called stereotactic radiosurgery, might result in even better survival results than radiation to the entire brain. Receiving this focused radiation was more common in patients who also had tumors in other parts of their body. While our study gives essential insights, it does have some limitations. The database we used doesn’t provide specific details like the size of the brain tumors, the exact treatment doses, and some other crucial patient information. This means that while we now have a better overall picture, more research is needed to give patients and doctors a complete understanding.

Tweetable abstract

Utilizing the National Cancer Database (2010–15), our study on brain metastases from testicular cancers reveals SRS improves overall survival more than whole brain radiation therapy.

Keywords::

• brain metastases
• radiation therapy
• stereotactic radiosurgery
• testicular cancer

Acknowledgments

The authors thank S Carey, MS, J Chang and J Newman of Allegheny Health Network’s Health System Publication Support Office (HSPSO) for their assistance in editing and formatting the manuscript. The HSPSO is funded by Highmark Health (PA, USA) and all work was done in accordance with Good Publication Practice (GPP3) guidelines (http://www.ismpp.org/gpp3).

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Medical writing support was provided by the Health System Publication Support Office (HSPSO), an internal service funded by Allegheny Health Network and to be used by researchers employed by Allegheny Health Network.

Ethical conduct of research

This project focused on a retrospective review of the NCDB, which is exempt from IRB review due to the de-identified nature of the dataset.

Additional information

Funding

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.