Abstract 373P
Background
Deciding the optimal treatment for patients with brain metastases (BM) remains challenging. For patients not candidates for surgery (S) or stereotactic radiosurgery (SRS), prognostic factors to identify those with a survival benefit after whole brain radiotherapy (WBRT) are needed. Prognostic scoring systems based on clinical trial data exist, but extracranial disease status is not part of most of these systems. Clinical trials typically include selected patients (i.e ≤4 BM, good performance status [PS]). Real-life data from unselected BM patients may supply such trial results in treatment decision making.
Methods
A population-based prospective observational study at four hospitals in Norway (up-take ≈3.5 million inhabitants). Consecutive patients with newly diagnosed BM from solid cancers were included. Clinical data were collected every 3 months (mo).
Results
930 patients (pt) were included Nov 2017-March 2021. In preliminary analyses of 771 pt with ≥ 6 mo follow-up (46% male, median age 68 [21-96]), most frequent primary cancers were lung (non-small cell, 44%), melanoma (16%), breast (15%) and colorectal (9%). 35% had ≥5 BMs, 45% had ECOG PS≥2, 79% had extracranial metastases. Median OS (mOS) after BM diagnosis for all patients was 6 mo, longest for breast (13 mo), shortest for colorectal (4 mo). 34% of pt died within 3 months, 8% lived >2 years. Age>75, male sex, PS≥2, ≥ 5 BM and presence of extracranial disease were associated with worse mOS in multivariable analyses. Primary BM treatments were: S 17%; SRS 34%; systemic 2%; no tumor-directed therapy 5%; 329 (43%) pt received WBRT, 157/329 (48%) died within 3 months after BM diagnosis. PS 0-1, age <65 and non-progressive extracranial disease were associated with longer survival in WBRT-treated patients.
Conclusions
Although some patients live >2 years after BM diagnosis, many still die within 3 mo. WBRT should be considered reserved to younger patients not suitable for other intracranial treatments with PS 0-1 and non-progressive extracranial disease, as many are unlikely to benefit in terms of OS. Extracranial disease status should be assessed before treatment decision making.
Clinical trial identification
NCT03346655.
Editorial acknowledgement
Legal entity responsible for the study
Oslo University Hospital.
Funding
The Regional Health Authority of South-Eastern Norway The Norwegian Cancer Society, Pink Ribbon.
Disclosure
All authors have declared no conflicts of interest.