Abstract
To study the patient load, treatment pattern, survival outcome and its predictors in patients with brain metastases treated by radiotherapy. Data for patients with brain metastases treated by radiotherapy between 2003 and 2007 were collected from medical records, the hospital information system database, and a population-based tumor registry database until death or at least 5 years after treatment and retrospectively reviewed. The number of treatments for brain metastases gradually increased from 48 in 2003 to 107 in 2007, with more than 70% from lung and breast cancers. The majority were treated with whole brain radiation of 30 Gy (3 Gy X 10 fractions) by cobalt-60 machine, using radiation alone. The overall median survival of the 418 patients was 3.9 months. Cohort analysis of relative survival after radiotherapy was as follows: 52% at 3 months, 18% at 1 year and 3% at 5 years in males; and 66% at 3 months, 26% at 1 year and 7% at 5 years in females. Multivariate analysis demonstrated that the patients treated with combined modalities had a better prognosis. Poor prognostic factors included primary cancer from the lung or gastrointestinal tract, emergency or urgent consultation, poor performance status (ECOG 3-4), and a hemoglobin level before treatment of less than 10 g/dl. This study identified an increasing trend of patient load with brain metastases. Possible over-treatment and under-treatment were demonstrated with a wide range of survival results. Practical prognostic scoring systems to assist in decision-making for optimal treatment of different patient groups is absolutely necessary; it is a key strategy for balancing good quality of care and patient load.
Highlights
Brain metastases are a significant cause of morbidity and mortality in the cancer population
Radiotherapy for Brain Metastases in Southern Thailand: Workload, Treatment Pattern and Survival treatment pattern, survival outcome and its predictors in patients with brain metastases treated by radiotherapy in the division
This study demonstrated the patient load, treatment pattern, and survival outcome of patients with brain metastases treated by radiotherapy at the Division of Therapeutic Radiology and Oncology, Songklanagarind Hospital between 2003 and 2007
Summary
Brain metastases are a significant cause of morbidity and mortality in the cancer population. In selected good prognostic patients, surgical resection (SX) in combination with WBRT has been proven to improve functionally independent survival (Hart et al, 2005) combined WBRT with radiosurgery (RSX) may result in better local control and survival (Patil et al, 2012) These modalities without WBRT have been investigated with the aim of avoiding the neurocognitive adverse effects of WBRT for better quality of life without compromising overall survival (Chang et al, 2009; Kocher et al, 2011; Soffietti et al, 2013; Duan et al, 2014). In patients with the worst prognoses, the role of WBRT is questionable when compared with good palliative care only (Estabrook et al, 2013; Langley et al, 2013; Nieder et al, 2013; Windsor et al, 2013)
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