ESTRO 2024 - Abstract Book

S1837

Clinical - Mixed sites, palliation

ESTRO 2024

Zeeshan Saeed 1 , Sonja Hanif 2 , John Reardon 3 , Kevin Davies 4 , Edward Chandy 3

1 University Hospitals Sussex NHS Foundation Trust, Internal Medicine, Brighton, United Kingdom. 2 Brighton & Sussex Medical School, Medicine, Brighton, United Kingdom. 3 University Hospitals Sussex NHS Foundation Trust, Clinical Oncology, Brighton, United Kingdom. 4 Brighton & Sussex Medical School, Internal Medicine, Brighton, United Kingdom

Purpose/Objective:

Whole Brain Radiotherapy (WBRT) is a treatment offered palliatively to patients with brain metastases. WBRT helps to control disease and to alleviate symptoms. However, WBRT is associated with side effects including fatigue, hair loss and cognitive decline and more targeted treatments, for example surgical resection or Stereotactic Radiosurgery, are now preferred where appropriate. Nonetheless, for some patients, WBRT remains a good option and is still commonly used. Numerous predominantly retrospective studies have evaluated the role of WBRT finding overall survival ranging widely from 2 months to 10 months. Our purpose was to retrospectively audit the use of WBRT at a single tertiary oncology centre over 10 years and analyse outcomes, patient and tumour factors, and examine any changing trends in its utilisation.

Material/Methods:

An audit was retrospectively conducted by collecting data from electronic radiotherapy databases, patient records and PACS. Data was collected for all patients receiving WBRT at our centre over 10 years (October 2011 – April 2022), dose and fractionation, diagnosis, toxicity, overall survival (OS), patient demographics and recursive partitioning analysis (RPA) classification which comprises age, primary disease control, extracranial metastases and Karnofsky performance status. Patients undergoing Prophylactic Cranial Irradiation (PCI) and those who died before commencement of WBRT were excluded. Statistical analysis was conducted on SPSS.

Results:

403 patients were identified with a median age of 64 years (range 25 to 85 years old). The main primary cancer diagnoses were Lung (non-small cell (NSCLC) n=143, small cell (SCLC) n=42) and breast cancer (n=82) comprising 66% of the total patient cohort. Additional primary cancers included colorectal (CRC; 4%), melanoma (4%), renal cell carcinoma (RCC; 3%), and others (22%). 337 patients (84%) were prescribed 20 Gray over 5 fractions WBRT. The rest received 25-30 Gray over 10 fractions. RPA score was calculable for 324 patients with a breakdown as follows: Class 1 (n=47, 15%), Class 2 (n=150, 46%), Class 3 (n=126, 39%). Median OS was 94 days for the whole cohort. OS significantly correlated with the RPA Class; with patients in RPA Class 1 having the best median OS of 196 days, in comparison to Class 2 with 110 days and Class 3 with 79 days (p<0.001). Also, patients under 65 years old had improved mean OS of 215 days versus 142 days in those aged over 65 (p<0.001). Median OS was influenced by primary cancer type: breast (149 days), melanoma (110 days), RCC (107 days), SCLC (104 days), NSCLC (88 days), and CRC (77 days) respectively. There was evidence of 103 patients (26%) being readmitted to hospital within 6 weeks of receiving WBRT, with proportion of total patients from each RPA class being: Class 1 (11/47; 23%), Class 2 (48/150; 32%), Class 3 (37/126; 29%).