EP1.16-44 Survival and Prognostic Association of Non-Small Cell Lung Cancer with Brain Metastases After WBRT: A Multicentre Study

Abstract

Forty percent of intracranial tumors are metastatic, arising most commonly from lung. To our knowledge, no data is available on prognosis factors of the survival of non-small cell lung cancer (NSCLC) patients with brain metastases in Bangladesh. This study aims to determine overall survival (OS) and identify prognosis factors in NSCLC patients with brain metastases after whole brain radiation therapy (WBRT). The study retrospectively investigated histologically proven NSCLC patients with brain metastases at two tertiary hospitals in Bangladesh from January, 2013 to April, 2018. A total of 62 patients were eligible who received 30 Gy (3 Gy per fraction) of WBRT. The primary end point was OS and the secondary endpoint was prognostic association with various factors including patient age and gender, tumor histology, Karnofsky performance status, pleural effusion, primary not controlled, extracranial metastases, the number of brain metastases, surgical resection and diagnosed initially with brain metastases or developed brain metastases later. RTOG Recursive Partitioning Analysis (RPA) was used to categorize the patients. Survival was calculated by Kaplan-Meier method and compared by Log-rank test. Prognostic association was evaluated with Cox proportional hazards model analysis. Mean survival of the entire cohort was 5.76 months (95% CI: 4.69 – 6.84 months). Patients with brain metastases at diagnosis or developed brain metastases later during disease progression had a statistically similar mean survival (6.18 months vs. 5.49 months; P = 0.422). Among the 62 patients, 16.1%, 30.6% and 53.2% were RPA Class I, II and III respectively. Mean survival differed significantly among the three classes (Class I: 9.10 months, Class II: 6.68 months, Class III: 3.64 months; P = 0.00). Individual prognostic factors were not found to be associated with survival difference except, single vs. multiple brain metastases (P = 0.042) and primary controlled or not (P = 0.026). The study reported survival time of NSCLC patients with brain metastases undergo WBRT, and indicated that higher RPA classes, primary not controlled and greater numbers of brain metastatic lesions are the three prognostic factors of poor survival for this cohort. Our results may help clinicians in patient counseling, treatment selection and designing future clinical trials.