Survival outcomes after whole brain radiotherapy

Abstract AIMS Cerebral metastases from extra-cranial primary cancer carries a poor prognosis. For patients in whom surgical resection or SRS are not suitable, local control rates are poor. There is considerable debate surrounding the value of whole brain radiotherapy in this patient cohort in terms of local control, survival and functional status. We aimed to measure survival in patients receiving whole brain radiotherapy at the Norfolk and Norwich University Hospital. METHOD All patients who completed a course of whole brain radiotherapy at our centre between April 2018 and December 2022 were retrospectively analysed. Patients who were receiving prophylactic cranial irradiation of small cell lung cancer were excluded. Baseline demographics, oncologist declared ECOG performance status at referral for treatment, radiotherapy dose and survival were recorded. RESULTS 88 patients received WBRT during this period. The median follow-up interval was 85 days. 12 patients received 30 Gy in 10 fractions, 59 received 20 Gy in 5 fractions and 17 received 12 Gy in 2 fractions. The median overall survival following completion of radiotherapy was 85 days. At 6 weeks after radiotherapy, 23.9% of patients had died. Univariate analysis with Cox proportional hazards model did not demonstrate a significant hazard ratio for age (<65 or ≥65), ECOG performance status or radiotherapy dose. CONCLUSIONS Survival following whole brain radiotherapy remains poor. In particular, almost a quarter of patients are not alive 6 weeks after treatment. This is particularly pertinent given the anticipated trajectory of acute toxicities from treatment.