Radiotherapy (RT) for brain metastases (BM) near the end of life (EOL): Palliation or poor-quality care?

Abstract

58 Background: Patterns of care and EOL RT among BM patients (pts) are not well-described. Methods: Tumor registry of an integrated health care system identified 5,133 pts diagnosed with non-small-cell lung cancer (NSCLC) in 2007-2011. BM were determined by imaging. Clinical variables obtained by chart abstraction were tested as predictors of death within 14 and 30 days (d) of RT. Results: On NSCLC presentation, 10% had BM; 7% developed BM thereafter. Of 900 BM pts, 15% were not referred for brain RT due to pt preference or clinical judgments; median time to death was 21 d (range 0-578). Median survival for 5% not recommended RT was 48 d (range 13-764). Though survival was shorter when prescribed 5 vs 10 fractions (78 vs 179 d, p<0.01), suggesting providers’ sense of prognosis, 15.6% of pts died ≤14 d and 23.3% ≤30 d of RT. Inpt consultation and planned fractions were higher at external RT facilities, and RT more likely not to be completed (p<0.01). Independent predictors of EOL RT were older age, poor performance status, increasing metastatic sites, and RT consultation during hospital admission. Conclusions: BM incidence in this NSCLC cohort was 17%, with 85% referred for brain RT. A concerning number of pts received RT near the EOL. While RT recommendation, timing, and fractionation – especially on inpt evaluation – should be better tailored to life expectancy, benchmarks for quality measurement are needed. [Table: see text]