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R. Jancalek

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Open access Aug 2026

Radiotherapy Modality and Primary Tumor Type as Determinants of Outcomes in Brain Metastases: A Retrospective Study of 734 Patients

Background and Objectives: Radiotherapy (RT) is a standard component of palliative treatment for brain metastases. The aim of this retrospective analysis of consecutive patients treated between 2017 and 2023 is to analyze overall survival after brain radiotherapy depending on the type of radiotherapy delivered and to monitor the shift from whole-brain radiotherapy (WBRT) to stereotactic radiotherapy (SRS/FSRT) in real-world practice before the era of routinely used modern brain-penetrant targeted therapy. Materials and Methods: A total of 734 patients treated with radiotherapy for brain metastases were analyzed. Clinical data were collected via an electronic hospital information system and radiotherapy details were obtained using the Eclipse™ treatment planning system. The survival analysis divides patients according to cancer types and according to the RT technique used. Results: A total of 734 patients (median age 65.2 years; 50.5% women) were analyzed, with 104 undergoing more than one course of radiotherapy. Lung cancer (42.3%) and breast cancer (17.2%) were the most common primary diagnoses. Median overall survival (OS) after radiotherapy for the entire cohort was 2.8 months (2.6–3.2 months). Survival varied by radiotherapy technique: 2 months for WBRT-based approaches, 5.7 months for stereotactic radiotherapy (SRS/FSRT), and 7 months for combined WBRT and stereotactic treatment. Breast cancer patients had the longest median OS (3.6 months), with substantially improved outcomes in those treated with stereotactic or combined approaches (12.8 and 11.9 months, respectively). A decline in treated patients was observed during the COVID-19 pandemic (notably in 2021) and a consistent increase in the use of stereotactic techniques between 2017 and 2023 was noted. Conclusions: A wide range of radiotherapy techniques are used in the treatment of brain metastases with the primary concern being the prognosis and diagnosis of a patient. A clearly identifiable trend is a shift away from WBRT toward an increased use of targeted stereotactic irradiation techniques for brain lesions. Overall survival varies significantly across primary sites with most favorable outcomes in breast cancer patients irradiated with SRS/FSRT.

L. Hnidakova, Andrea Pagacova, Sarka Kristkova et al. · Medicina · 0 citations

Open access Jul 2026

Glioblastoma in adults with prior extracranial cancer: a Czech retrospective multicentre study

Background Patients with a history of extracranial cancers (EXCA) who develop new intracranial lesions are commonly presumed to harbour brain metastases, yet primary glioblastoma (GBM) can also arise de novo in cancer survivors. The clinical course, molecular features, and treatment outcomes of GBM in this population remain incompletely characterised. Methods We retrospectively analysed adult patients with concurrent prior solid EXCA and supratentorial GBM treated at three Czech neuro-oncology centres between January 2010 and December 2022. Patients with hematologic malignancies or needle-biopsy-only diagnoses were excluded. Demographic, clinical, molecular (IDH, MGMT), surgical (RANO RESECT 2022 extent-of-resection classification), and treatment data were collected and related to progression-free survival (PFS) and overall survival (OS) using Kaplan–Meier estimation, log-rank tests, and Cox regression. Results Of 1,182 patients operated for GBM, 48 (4.0%) had a documented prior solid EXCA. Median age at EXCA diagnosis was 57.5 years (range 21–82); median age at GBM diagnosis was 65 years (range 46–82). The median interval between diagnoses was 5.7 years (range 0.1–27.3). All 48 GBMs were IDH-wildtype; MGMT promoter status was assessable in 23 cases (17 unmethylated, 6 methylated), of which 22 had follow-up data available for survival analysis. Median PFS was 8.4 months (95% CI 7.6–27.3) and median OS was 10.6 months (95% CI 5.7–16.8). MGMT methylation (mOS 29.3 vs 12.0 months; p = 0.037), higher Karnofsky score, more radical surgical resection, and completion of the Stupp protocol (mOS 19.2 vs 2.5 months for no oncotherapy; p = 0.019) were each significantly associated with longer OS. Conclusions A new brain lesion in a cancer survivor must not be assumed to be metastatic without histological confirmation. When patients with GBM after prior EXCA are eligible for standard radical surgery and Stupp-protocol oncotherapy, survival outcomes are comparable to those reported for sporadic GBM. Standard treatment protocols are appropriate for this population; a history of extracranial cancer is not in itself an adverse prognostic factor.

Ondřej Kalita, Tomas Kazda, S. Tomoszková et al. · Frontiers in Oncology · 0 citations