Brain metastases: treatment patterns and outcomes at Charlotte Maxeke Johannesburg Academic Hospital Radiation Oncology Department

Abstract

Background: Improved therapies in cancer care have resulted in an increased incidence of patients with a diagnosis of brain metastases. Despite this, patient outcomes remain poor. Aim: We reviewed treatment patterns and outcomes of patients with brain metastases following whole brain radiation therapy (WBRT) Setting: Charlotte Maxeke Johannesburg Academic Hospital Department of Radiation Oncology, during the period 1 July 2016 -30 June 2017. Methods: A retrospective record review of patients who received WBRT. Demographic and clinical data was collated in a data sheet and descriptive analysis performed using STATA Software 13 version. Survival analysis was done using Kaplan Meier method. All tests were considered statistically significant for p<0.05. Results: A total of 89 patient records were reviewed of which 64 met the inclusion criteria. The mean age was 50.7 years, with a range of 24 to 76 years. Patients were predominantly female, (n= 51, 79.7%). The most common primary malignancies were breast (n=36, 56.3%) and lung (n=9, 14.1%). Only 2 (3.1%) cases were biopsy proven, with majority of cases being diagnosed radiographically by CT scan (n=60, 93.8%). MRI was done in only 8 (12.5%) patients. Over half of the cohort, (n=33, 51.6%) presented with headache, followed by motor weakness/gait disturbances in 31 (48.4%) patients. All patients received steroids at some point in their treatment. The most frequent radiation prescription dose given was 20Gy in 5 fractions; in 60 (93.8%) patients. Of these, 45 (70.3%) patients completed their radiation therapy. At 3 and 6 months follow up, 14 (77.8%) and 9 (81.8%) patients respectively reported improvement in symptoms following treatment. A total of 45 (70.3%) deaths were registered at 1 year following WBRT. Forty one (64.1%) of these patients died within the first month following WBRT. Of these, 25 (39.1%) died within one week. The median survival of patients was 3.4 months. Patients in RPA class 3 predictably had the worst overall survival (p=0.0088). Whilst breast cancer patients had a worse overall survival than lung cancer patients, there was no statistically significant difference in survival functions for gender and age group. Conclusion: WBRT may improve symptoms in patients treated for brain metastases, however the survival of majority of these patients remains poor in our clinical setting