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

Figures & data

Figure 1. CONSORT diagram indicating inclusion criteria for the study and how patients were classified.

Radiotherapy treatments included whole brain radiation therapy and stereotactic radiosurgery.

Mets: Metastases; SRS: Stereotactic radiosurgery; WBRT: Whole brain radiation therapy; XRT: Radiotherapy.

Table 1. Characteristics of patients with primary testicular cancer and brain metastases.

	No.	%
Race
White	304	89
Black	16	5
Other	22	6
Comorbidity score (Charlson-Deyo)
0	283	83
1	50	15
>2	9	3
Insurance
Not insured	64	19
Private	150	44
Medicaid	95	28
Medicare	21	6
Other Government	5	1
Insurance status unknown	7	2
Median household income
<$40,227	62	19
$40,227–$50,353	92	28
$50,354–$63,332	90	27
>$63,332	86	26
Treatment facility type
Community Cancer Program	7	2
Comprehensive Community Cancer Program	32	9
Academic/Research Program	24	7
Integrated Network Cancer Program	18	5
Information not available	261	76
Facility location urban/rural
Metro	294	86
Urban	36	11
Rural	4	1
Data not available	8	2
Age
≤28	174	51
>28	167	49
Year of diagnosis
2010–2011	106	31
2012–2013	124	36
2014–2015	112	33
Radiation
No radiation	204	60
WBRT	101	30
SRS	34	10
Unknown	3	1
Primary malignancy
Seminoma	13	4
Non-seminoma	329	96
Distance to facility
≤38.9 miles	287	84
>38.9 miles	55	16
Dosage information
Median Phase 1 Total Dose (WBRT) (cGy)	3000
Q1 Phase 1 Total Dose (WBRT) (cGy)	1950
Q3 Phase 1 Total Dose (WBRT) (cGy)	3750
Median Phase 1 Total Dose (SRS) (cGy)	2400
Q1 Phase 1 Total Dose (SRS) (cGy)	2100
Q3 Phase 1 Total Dose (SRS) (cGy)	4605
Median fractions (WBRT)	10
Median fractions (SRS)	1
Chemotherapy administered
Yes	305	89
No	37	10
Extracranial disease
No	28	8
Yes	314	91

SRS: Stereotactic radiosurgery; WBRT: Whole brain radiation therapy.

Table 2. Multivariable logistic regression for receipt of stereotactic radiosurgery.

Characteristic	OR (95% CI)	p-value
Age
≤28	Reference
>28	0.53 (0.24–1.17)	0.12
Comorbidity score
0	Reference
1	2.13 (0.81–5.62)	0.13
≥2	1.71 (0.19–15.60)	0.63
Distance to facility, miles
≤38.92	Reference
>38.92	0.50 (0.15–1.62)	0.25
Extracranial disease
No	Reference
Yes	0.30 (0.09–1.01)	0.05
Histology
Seminoma	Reference
Non-seminoma	3.15 (0.18–54.21)	0.43
Insurance status
Not insured	Reference
Private	3.30 (0.88–12.5)	0.078
Government	2.86 (0.75–10.96)	0.13
Status unknown	10.71 (1.11–103.72)	0.041
Race
White	Reference
Black	0.26 (0.015–4.38)	0.35
Other	0.30 (0.037–2.52)	0.27
Year of diagnosis
2010	Reference
2011	2.37 (0.62–9.10)	0.21
2012	0.63 (0.13–3.10)	0.56
2013	0.89 (0.22–3.63)	0.87
2014	1.85 (0.47–7.25)	0.38
2015	2.04 (0.55–7.56)	0.28

Bolded p-values represent statistically significant demographic predictors of a patient receiving stereotactic radiosurgery.

Table 3. Multivariable Cox regression for predictors of survival.

Characteristic	Hazard ratio (95% CI)	p-value
Extracranial disease
No	Reference
Yes	1.71 (0.86–3.39)	0.13
Treatment
WBRT	Reference
SRS	0.49 (0.27–0.88)	0.016
Chemotherapy	0.65 (0.47–0.88)	0.0062
No treatment	2.63 (1.56–4.45)	0.0003
Age
≤28	Reference
>28	1.33 (1.00–1.77)	0.050

Bolded p-values represent statistically significant predictors of survival.

SRS: Stereotactic radiosurgery; WBRT: Whole brain radiation therapy.

Figure 2. Overall survival of all patients (39%) in the study recorded in the 5 years post-diagnosis.

Median survival was 16 months. Survival at 1 and 5 years was 59% and 39%, respectively.

Figure 3. Overall survival of the cohort post-diagnosis distinguished by treatment received: whole brain radiation therapy, stereotactic radiosurgery and chemotherapy.

The highest 5-year survival rate was observed in patients receiving SRS (58%), followed by chemotherapy (47%) and WBRT (25%) compared with untreated patients (19%).

Chemo: Chemotherapy; SRS: Stereotactic radiosurgery; WBRT: Whole brain radiation therapy.