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

Abstract

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.

Real‐world data on patterns and outcomes of radiation therapy for brain metastases in a population‐based cohort of lung cancer patients in Victoria

“…reported a marked increase in SRS use from 7% in 2004 to 27% in 2014. The use of SRS for BM in patients with LC in a population‐based cohort in British Columbia, Canada, for a similar period (2014–2015), however, was much lower at around 11% 20 …”

“…Several large single institutional studies in the UK, the United States and New Zealand have reported 30M following palliative RT for BM in the range of 11–23% 11–13 . In a Canadian population‐based study, Schlijper et al 20 . reported a longer time frame of 90‐day mortality following RT for BM of 40% in a cohort of 740 patients with LC in British Columbia.…”

“…The use of SRS for BM in patients with LC in a population-based cohort in British Columbia, Canada, for a similar period (2014-2015), however, was much lower at around 11%. 20 We identified several factors to be associated with SRS use. Younger patients were more likely to be treated with SRS, which may reflect better performance status and more favourable prognosis in this group of patients.…”

“…Several large single institutional studies in the UK, the United States and New Zealand have reported 30M following palliative RT for BM in the range of 11-23%. [11][12][13] In a Canadian population-based study, Schlijper et al 20 reported a longer time frame of 90-day mortality following RT for BM of 40% in a cohort of 740 patients with LC in British Columbia. The reasons behind delivering RT for BM within 30 days of death is likely multifactorial, in part due to challenging prognostication of patients, overly optimistic expectations of the potential benefits of RT by the referring clinicians, and probably patients and families' unrealistic perception of disease in seeking active treatment.…”