Abstract 142P
Background
For NSCLC patients with BM were RT is considered, both WBRT and stereotactic RT (SRT) are established options. As the evidence for potential benefits of RT in patients with BM and poor performance status is meager, the risk for overtreatment is high. The aim of our study was to analyze overall survival (OS) after radiotherapy for patients with first-time BM in relation to ECOG performance status.
Methods
In a prospective cohort study, 294 consecutive NSCLC patients (pts) with newly diagnosed BM with RT as initial treatment, were included from November 2017 to March 2021. Clinical and treatment related data were collected every 3 months for up to 2 years. Median OS (mOS) was calculated from start of RT to death or last follow up (October 2022).
Results
At time of analysis, 42 pts (22%) were still alive. Median OS was 4.0 months (mo), 2.0 mo after WBRT (n = 141); 7.0 mo after SRT (n = 153). After WBRT, pts with ECOG 2 and pts with ECOG 3-4 had equal mOS (1.0 mo). After SRT, mOS was 4.0 mo and 1.0 mo for ECOG 2 and ECOG 3-4, respectively. In multivariate analysis age ≥70, WBRT and ECOG ≥2 were associated with short survival.
Table: 142P| ECOG status | ||||
|---|---|---|---|---|
| ECOG 0-1 | ECOG 2 | ECOG 3-4 | Unknown | |
| WBRT N 141 (%) | 62 (44) | 46 (33) | 29 (20) | 4 (3) |
| mOS WBRT months | 4.0 (2.1–5.9) | 1.0 (0.5–1.5) | 1.0 (0.4–1.6) | |
| SRT N 153 (%) | 96 (63) | 39 (25) | 18 (12) | |
| mOS SRT months | 11.0 (6.6–15.3) | 4.0 (2.0–6.0) | 1.0 (0.0–2.4) |
Conclusions
After WBRT, pts with ECOG 2 has equally poor mOS (1.0 month) as patients with ECOG 3-4.
Consequently, we suggest that WBRT should not be given to patients with ECOG 2 or worse. Although other clinical factors (i.e. targeted treatment options) and the patient's opinion must be included in treatment decision, most of these patients seem to be at risk of experiencing only the side effects of WBRT with little or no benefit on symptoms or survival. Instead, they should rather be considered for best supportive care alone to improve quality of life at the end of life.
Legal entity responsible for the study
The authors.
Funding
Southern and Eastern Norway Regional Health Authority and Pink Ribbon, Norwegian Cancer Society.
Disclosure
All authors have declared no conflicts of interest.