Radiotherapy (RT) is frequently used in brain metastases (BM) treatment. RCTs show equal survival after stereotactic RT (SRT) and whole-brain RT (WBRT) in patients with favorable prognostic factors (i.e. ≤4 BM, good performance status [PS]), while WBRT may not improve survival in patients with more advanced cancer. We investigated what type of anticancer treatments pts were offered at the time of primary BM diagnosis. Patients were grouped according to anticancer treatments and known prognostic criteria. Survival and patient-reported outcomes (PROs) were compared between groups in this “real-life cohort” of consecutive, unselected BM pts.
A population-based prospective observational study at 5 hospitals in Norway (covering ≈70% of the Norwegian population). Clinical data were collected every 3 months, PROs monthly for 1 year.
914 patients were included (46 % male, median age 69 [21-96]). Most frequent primary cancers were lung (non-small cell, 41%), melanoma (16%), breast (14%) and colorectal (10%). 31% had ≥5 BM, 82% were symptomatic, 41% had ECOG PS ≥2, 80% had extracranial metastases (ECM). Primary BM treatments were: Surgery 17%; SRT 34%; WBRT 40%, systemic treatments 3%; best supportive care (BSC) 6%. Median OS (mOS) after BM diagnosis for all was 6 months (surgery: 13, SRT: 9, systemic: 8, WBRT: 3, BSC: 1). In patients treated with WBRT, 71% had ≥5 BM, 50% ECOG 2-4, 87% ECM, 50% were ≥70 years. mOS for WBRT patients with ECOG 0, 1, 2 and 3-4 was 9, 4, 2 and 2 months, respectively. At inclusion, patients in the WBRT group reported significantly poorer scores for physical functioning (PF) and global quality of life (QoL) compared to those in the surgery and SRT groups. After 2 months, PF, QoL and fatigue scores significantly worsened in the WBRT group, with no change after surgery or SRT.
Clinical data (ECOG, ECM status) and PROs indicate a need for more careful selection of patients offered WBRT. Due to particularly short survival, patients with ECOG 3-4, and perhaps controversially also ECOG 2, may not be able to profit from WBRT. These patients should instead be considered for BSC alone.
Clinical trial identification
Legal entity responsible for the study
Oslo University Hospital.
The Norwegian Cancer Society. South-East Health Care Region of Norway.
O.E. Yri: Non-Financial Interests, Personal and Institutional, Advisory Board: AstraZeneca. All other authors have declared no conflicts of interest.