Defining treatment for brain metastases patients: nihilism versus optimism

Aims Treatment of brain metastases patients has included whole brain radiotherapy (WBRT) for over 50 years, and there is much data showing this to be associated with short-term gains. The integration of resection and radiosurgery to these patients allows some better prognostic groups to experience l...

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Bibliographic Details
Published in:Supportive care in cancer 2012-02, Vol.20 (2), p.279-285
Main Authors: Craighead, Peter S., Chan, Alexander
Format: Article
Language:English
Subjects:
Age Factors
Aged
Alberta
Brain
Brain damage
Brain Neoplasms - radiotherapy
Brain Neoplasms - secondary
Brain Neoplasms - surgery
Cancer
Care and treatment
Combined Modality Therapy
Decision Making
Humans
Medical prognosis
Medicine
Medicine & Public Health
Metastasis
Middle Aged
Neoplasms - pathology
Nuclear radiation
Nursing
Nursing Research
Oncology
Original Article
Pain Medicine
Prognosis
Quality of Life
Radiation therapy
Radiosurgery
Radiosurgery - methods
Rehabilitation Medicine
Retrospective Studies
Survival Rate
Treatment Outcome
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Summary:Aims Treatment of brain metastases patients has included whole brain radiotherapy (WBRT) for over 50 years, and there is much data showing this to be associated with short-term gains. The integration of resection and radiosurgery to these patients allows some better prognostic groups to experience long-term local control and improvement in quality of life. The recursive partitioning analysis of the Radiation Therapy Oncology Group (RTOG) has been used as a predictive model for over a decade to identify three classes of patients. Number of lesions has been used to define treatment for a good prognostic subgroup that is eligible for surgery or radiosurgery, but there are few prospective studies of poorer prognosis brain metastases patients to evaluate the influence of number of lesions on the prediction of outcome. We examined patient, treatment and outcome parameters of all brain metastases patients in a 5-year period so that we could measure outcome and evaluate various factors on survival. Methods and results This was a population-based study of all brain metastases patients in Southern Alberta between 2000 and 2005. It used an Excel spreadsheet database and STATA 8 software to analyze outcomes. The study included 568 patients representing 4.4% of our radiotherapy population. Median age, performance status and distribution of primary disease sites were comparable with other large series. Overall survival for the whole group was 3.05 months. Independent factors predicting for improved overall survival included younger age, KPS
ISSN:0941-4355
1433-7339
DOI:10.1007/s00520-010-1068-6