Survival after whole brain radiotherapy for brain metastases from lung cancer and breast cancer is poor in 6325 Dutch patients treated between 2000 and 2014

Jeene, Paul M.; Vries, Kim C. de; Nes, Johanna G. H. van; Kwakman, Johannes J.M.; Wester, G.; Rozema, Tom; Braam, P.M.; Zindler, Jaap; Koper, P.; Nuyttens, J.; Vos-Westerman, Hanneke; Schmeets, Ilona; Niël, C.; Hutschemaekers, S.; Linden, Yvette M. van der; Verhoeff, J.; Stalpers, Lukas J.A.

doi:10.1080/0284186x.2017.1418534

Cited by 33 publications

(23 citation statements)

References 30 publications

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“…Authors explain short survival rates with the inclusion of patients who might have been judged unfit under different conditions. In a Dutch trial of 1962 breast cancer patients with BMs treated in 15 different institutions with WBRT, median survival was also only 3.7 months [23]. This is in line with our data showing lower survival rates in a real-world setting compared with other trials with a WBRT rate of 70% (1193/1721 patients).…”

Section: Discussionsupporting

confidence: 89%

Treatment and outcomes of patients in the Brain Metastases in Breast Cancer Network Registry

Witzel

Laakmann

Weide³

et al. 2018

European Journal of Cancer

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Section: Discussionsupporting

confidence: 89%

Treatment and outcomes of patients in the Brain Metastases in Breast Cancer Network Registry

Witzel

Laakmann

Weide³

et al. 2018

European Journal of Cancer

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“…This population-based study demonstrates that between 2014-2015 the majority of lung cancer patients in BC, Canada, were treated with WBRT for brain metastases (86% of all treatment courses) and 40% of patients die within 90 days of start of radiation. This is an alarming rate given that brain radiotherapy, especially WBRT, can be associated with considerable side-effects and that the addition of WBRT to best supportive care may not significantly increase survival or improve quality of life [4,10]. Our findings suggest that at a provincial level, a re-evaluation of indications for WBRT and stereotactic treatment for patients with lung cancer is required.…”

Section: Discussionmentioning

confidence: 88%

“…However, selection criteria for the different radiotherapy options are a topic of debate. Prior studies have shown that patients with brain metastases from lung cancer, treated with WBRT, have a median overall survival of approximately 2.5-4.5 months [9][10][11]. The Quality of Life after Treatment for Brain Metastases (QUARTZ) trial identified no significant difference in survival or quality of life between patients treated with WBRT and optimal supportive care vs. optimal supportive care alone.…”

Section: Introductionmentioning

confidence: 99%

Patterns of Radiotherapy Utilization for Lung Cancer Patients with Brain Metastases: A Population-based Analysis

Schlijper

Fraser

Regan

et al. 2019

Cureus

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Introduction: Brain metastases occur in 15%-20% of lung cancer patients. Recently, studies have suggested that whole-brain radiotherapy (WBRT) may not prolong survival for a subset of patients, and is associated with significant side-effects. Furthermore, it is hypothesized that radiotherapy is often given near the end-of-life when the potential for benefit is minimal. Therefore, this study investigates how frequently radiotherapy for brain metastases is given near the end-of-life in a population-based cohort.Materials and methods: All lung cancer patients who received radiotherapy in British Columbia for brain metastases in 2014-2015 were identified. Patient and treatment characteristics were collected and analyzed to assess associations with death within 90 days of first radiation treatment.Results: In total, 740 patients were identified, with a total of 826 courses of brain radiation. The 90-day mortality rate was 40% (n=330). Multivariable analysis demonstrated higher odds for age (odds ratio (OR) = 1.04, 95% confidence interval (CI) 1.02-1.05), Eastern Cooperative Oncology Group (ECOG) performance score of 2 or higher (OR = 1.59, 95% CI 1.09-2.31) and squamous cell carcinoma (OR = 2.10, 95% CI 1.13-3.90) and lower odds for initial systemic therapy (OR = 0.48, 95% CI 0.34-0.68), more than five fractions of radiotherapy (OR = 0.25, 95% CI 0.16-0.39) and stereotactic radiation (OR = 0.29, 95% CI 0.13-0.65).Conclusion: In our population-based study, WBRT is given in 86% of radiotherapy courses for brain metastases from lung cancer. Of these patients, 40% received treatment near the end-of-life. We identified several factors associated with shortened survival. Using these factors and already established prognostic tools, WBRT utilization should be decreased in the future, improving individualized treatment for patients with brain metastases from lung cancer.

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“…Data on referral rates out of region for stereotactic treatment were not available suggesting that the overall central nervous system treatment rate is likely to be higher than that calculated. The overall prognosis of patients with cerebral metastases treated with whole brain radiotherapy is poor and the patients receiving whole brain radiotherapy in this study are likely to have been selected on the basis of poor prognostic factors precluding a stereotactic approach. The recent publication of the quality of life after treatment for brain metastases study where dexamethasone was not inferior to whole brain radiotherapy may help clinical decision‐making in this difficult area …”

Section: Discussionmentioning

confidence: 99%

Population‐based analysis of radiotherapy and chemotherapy treatment in the last month of life within regional Australia

Pitson

Matheson

Garrard

et al. 2020

Internal Medicine Journal

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Background: Cancer treatment near end of life is not likely to add meaningful benefit and minimising intervention rates has been promoted as an indicator of quality of care. Population-based analysis of treatment allows comparative analysis of treatment rates and provides insight into patterns of care.Aims: To report a population-based analysis of both radiotherapy and active systemic therapy (AST) delivery rates along with patterns of treatment within the last 14 and 30 days of life.Methods: The Evaluation of Cancer Outcomes Registry records clinical information on all newly diagnosed cancer patients for the Barwon South West Region of Victoria, Australia. Diagnosis details, tumour type and stage as well as core treatment details and date of death were extracted for all patients diagnosed from 2009 to 2015 inclusive.Results: A total of 12 760 cases cancers were recorded. The median age of all cases was 68.8, and 53% were male. AST was received by 3699 (29%) of patients and radiotherapy by 3811 (30%). Patient deaths within 14 and 30 days of treatment for AST were 4.3 and 8.7%, respectively, and deaths within 14 and 30 days of treatment for radiotherapy 3.8 and 8.0% respectively. Factors associated with death within 30 days of AST and/or radiotherapy were male gender, age greater than 70 years and higher disease stage (all P < 0.01). Treatment rates within 30 days of death were highest for lung cancer (23% of cases) and lowest for breast cancer (2% of cases). Conclusions:This population-based analysis of AST and radiotherapy treatment within the last 30 days of life within a region of Australia has shown overall treatment rates below 10%. Treatment rates appear influenced by both patient and tumour characteristics. Future focus on subgroups with high rates of late intervention may help minimise treatment unlikely to add benefit. PC Ref/dead (%) PC Ref/alive (%) P-value Any treatment 30-day outcomes 317/608 (52) 1207/5190 (23) <0.01 Any treatment 14-day outcomes 135/299 (45) 1403/5595 (25) <0.01 Radiotherapy 30-day outcomes 184/309 (60) 878/3502 (25) <0.01 Radiotherapy 14-day outcomes 76/147 (52) 986/3664 (27) <0.01 Active systemic therapy 30-day outcomes 142/323 (44) 827/3376 (25) <0.01 Active systemic therapy 14-day outcomes 63/160 (39) 906/3539 (26) <0.01Population-based end-of-life care review

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Survival after whole brain radiotherapy for brain metastases from lung cancer and breast cancer is poor in 6325 Dutch patients treated between 2000 and 2014

Cited by 33 publications

References 30 publications

Treatment and outcomes of patients in the Brain Metastases in Breast Cancer Network Registry

Treatment and outcomes of patients in the Brain Metastases in Breast Cancer Network Registry

Patterns of Radiotherapy Utilization for Lung Cancer Patients with Brain Metastases: A Population-based Analysis

Population‐based analysis of radiotherapy and chemotherapy treatment in the last month of life within regional Australia

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