{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T17:08:23Z","timestamp":1778260103096,"version":"3.51.4"},"reference-count":10,"publisher":"Wiley","issue":"24","license":[{"start":{"date-parts":[[2024,12,20]],"date-time":"2024-12-20T00:00:00Z","timestamp":1734652800000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Medicine"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>The role of whole\u2010brain radiotherapy for patients with brain metastases is changing as immunotherapy and molecularly targeted therapies advance. However, whole\u2010brain radiotherapy continues to be part of the multimodal concept.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective study included 285 patients who received whole\u2010brain radiotherapy for brain metastases, using a median dose of 30\u2009Gy. The study analyzed prognostic factors for survival using Cox regression analyses, while two landmark analyses, reflecting a minimum survival of 60 and 90\u2009days, accounted for early deaths. Neurological symptoms were compared before and after treatment using the McNemar test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The median patient age was 62\u2009years. Non\u2010small cell lung cancer (<jats:italic>n<\/jats:italic>\u2009=\u200995), breast cancer (<jats:italic>n<\/jats:italic>\u2009=\u200953), and small cell lung cancer (<jats:italic>n<\/jats:italic>\u2009=\u200948) were the most frequent cancer types. Median survival was 4.3\u2009months (interquartile range 1.8\u201311.1). In the multivariable Cox regression model, patients who received additional immunotherapy\/molecularly targeted therapy had a higher chance of survival than others. Overall survival was influenced by control of primary cancer, extracranial metastases, age, Karnofsky performance status, and number of brain metastases. The 90\u2010day landmark analysis included 181 patients who survived at least 90\u2009days, reflecting that 104 patients (36.5%) died within the first 90\u2009days. The 90\u2010day landmark analysis confirmed all predictive variables for survival. Patients who died before the 90\u2010day landmark endpoint had more brain metastases, lower Karnofsky performance status, higher age, and were less frequently treated with immunotherapy\/molecularly targeted therapy than those surviving at least 90\u2009days. The treatment significantly improved neurological symptoms.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>These results indicate an insufficient patient selection, as one\u2010third of patients treated with whole\u2010brain radiotherapy died within 90\u2009days. However, neurological symptoms improved, and the addition of immunotherapy and\/or molecularly targeted therapy to whole\u2010brain radiotherapy was associated with better survival. Patients receiving whole\u2010brain irradiation should be more carefully selected.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p>ClinicalTrials: 24\u20103626\u2010104<\/jats:p><\/jats:sec>","DOI":"10.1002\/cam4.70522","type":"journal-article","created":{"date-parts":[[2024,12,20]],"date-time":"2024-12-20T12:35:01Z","timestamp":1734698101000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Is Whole\u2010Brain Radiotherapy for Brain Metastases an Overestimated Therapy? A Retrospective Study of Real\u2010World Data Using Landmark Analyses"],"prefix":"10.1002","volume":"13","author":[{"given":"Florian","family":"Hoelzl","sequence":"first","affiliation":[{"name":"University of Regensburg  Regensburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oliver","family":"Koelbl","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University Hospital of Regensburg  Regensburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7435-9337","authenticated-orcid":false,"given":"Isabella","family":"Gruber","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology University Hospital of Regensburg  Regensburg Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,12,20]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prro.2022.02.003"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annonc.2021.07.016"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(21)00545-3"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.03.145"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)30825-X"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0360-3016(96)00619-0"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2009.08.025"},{"issue":"4","key":"e_1_2_11_9_1","article-title":"Whole Brain Radiotherapy for the Treatment of Newly Diagnosed Multiple Brain Metastases","volume":"2012","author":"Tsao M. N.","year":"2012","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.15386\/cjmed-1040"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/0360-3016(81)90005-5"}],"container-title":["Cancer Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cam4.70522","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,2,7]],"date-time":"2025-02-07T08:55:39Z","timestamp":1738918539000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/cam4.70522"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12]]},"references-count":10,"journal-issue":{"issue":"24","published-print":{"date-parts":[[2024,12]]}},"alternative-id":["10.1002\/cam4.70522"],"URL":"https:\/\/doi.org\/10.1002\/cam4.70522","archive":["Portico"],"relation":{},"ISSN":["2045-7634","2045-7634"],"issn-type":[{"value":"2045-7634","type":"print"},{"value":"2045-7634","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,12]]},"assertion":[{"value":"2024-10-19","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-12-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70522"}}