P08.08 * WHOLE BRAIN RADIOTHERAPY FOR CEREBRAL METASTASES - A COMPARISON OF OUTCOMES AT A SINGLE INSTITUTION IN 2008 AND 2012

Abstract

BACKGROUND: Whole brain radiotherapy (WBRT) is commonly used to treat cerebral metastases. However there is very sparse data to show the benefit of this treatment, which may cause considerable toxicity. We compared survival outcomes following WBRT at our centre during 2012 to those treated during 2008. METHODS: Computerised records of all patients receiving WBRT for cerebral metastases at our centre during 2008 and 2012 were examined. Patients receiving post-operative WBRT following resection or radiosurgery, and those receiving prophylactic cranial irradiation or re-irradiation, were excluded. Overall survival (OS) was calculated from the date of the first fraction, using Kaplan-Meier estimates. RESULTS: 217 patients received WBRT in 2008, 174 patients in 2012. The commonest diagnoses were NSCLC and breast cancer. In 2008, 43% had NSCLC and 21% had breast cancer. In 2012, 24% had NSCLC and 38% had breast cancer. Median OS was 2.63 months in 2008 and 2.92 in 2012 (p = 0.139). For patients with NSCLC, median OS was 2.63 months in 2008, 2.43 months in 2012 (p = 0.950). For those with breast cancer, median OS was 4.90 months in 2008, 3.29 months in 2012 (p = 0.374). OS for those with small cell lung cancer improved from 1.48 months in 2008 to 3.48 months in 2012 (p = 0.001). In both years, patients aged >60 had a poorer outcome. Although patients with breast cancer generally did better than others, those with Her2-negative breast cancer had a similar median OS and 3-month OS to NSCLC, although 6-month, 9-month and 12-month OS was better. CONCLUSION: Since the 2008 results were released to our centre, the overall number of courses of WBRT has reduced, as has the proportion of patients with NSCLC. Experience with the MRC QUARTZ study may have contributed to this. Conversely, there was an increase in the number and proportion of patients with breast cancer receiving WBRT - this did not translate into improved survival, in fact there was a trend towards poorer outcome in 2012 than in 2008. The best survival outcomes were in younger patients with Her2-positive breast cancer. Because of the limited survival for the majority of patients after WBRT, patient selection is paramount, requiring careful consideration of age, performance status, status of extra-cranial disease, options for further systemic therapy, etc. Prognostic assessment tools, such as the Graded Prognostic Assessment score, can guide such decisions.