How often do metastatic brain disease patients prescribed ten fractions of whole brain radiation therapy die without completing treatment?

Abstract

e23146 Background: Palliative whole brain radiation therapy (WBRT) is an established treatment modality for optimizing intracranial disease control in patients with metastatic brain disease, most commonly prescribed to a dose of 30 Gy in 10 fractions. The fidelity of WBRT course completion has not been rigorously evaluated. Methods: Two prospective institutional databases evaluating patients treated from April 2015 through December 2018 identified patients who received WBRT. Information analyzed included prescribed and delivered dose/fractionation, Karnofsky Performance Status (KPS), admission status, treatment duration, and time between WBRT completion and patient hospice referral/death. Results: 52 consecutive patients prescribed WBRT to 30 Gy in 10 fractions were evaluated. Twenty-six (50%) were inpatients, and only 17 (33%) had a KPS of 70 or greater (able to care for self). More than 30% failed to finish more than 5 of their 10 scheduled fractions before either death or hospice referral; only 29 of 52 patients (56%) finished WBRT as prescribed. Twenty-five patients (48%) died within 30 days of WBRT. Of the 29 patients who finished WBRT as prescribed, 9 (31%) died within 30 days of completing treatment. Of the 23 patients who failed to complete standard fractionation WBRT, nearly 70% died within 30 days of receiving their final radiation therapy fraction. Conclusions: These findings indicate that greater than 40% of patients prescribed the standard 10 fraction regimen of WBRT do not remain well enough to tolerate the full duration of treatment. With nearly half of patients dying within 30 days of standard fraction WBRT, there should be strong incentive to reduce the physical and financial burden on this patient population by prescribing WBRT with significantly shorter (i.e. single-fraction or 20 Gy in 5 fractions) fractionation schemes.