RADIOTHERAPY FOR BRAIN METASTASES NEAR THE END OF LIFE

Background: Patients (pts) with brain metastases may be referred for brain radiotherapy (BrRT) when exclusive palliative management would be the most appropriate care. Objective: To assess the incidence of the use of BrRT during end-of-life (EOL) care and to evaluate the clinical factors characterizing the pts who underwent BrRT during this period. Methods: The sample comprised pts from three independent oncology centers in Brazil, who had undergone BrRT for metastases. The variables included were performance status (ECOG), primary tumor type, extracranial metastatic status, neurological symptomatic status, the number and size of the brain metastatic lesions, posterior fossa or meningeal involvement, the modality of brain radiotherapy delivered, having undergone brain metastasectomy, and systemic therapies administrated. From the time BrRT was initiated, pts were allocated into three subgroups with ≤30, ≤60, and ≤90 days of survival (EOL subgroups), and a control group of pts who survived for more than 90 days. Statistically significant differences between the different groups were determined using the chi-squared, Fisher’s exact, or the Mann-Whitney U test. Multivariable analysis with Cox proportional hazards models was undertaken including variables with p values less than 0.1 on univariate analysis. RESULTS A total of 445 pts were included in the study, of which 95 (21.34%), 158 (35.50%), and 200 (44.94%), died within 30, 60, and 90 days, respectively. An ECOG score ≥2 (<0.05) and the lack of systemic treatment administration following BrRT (<0.01) were significantly associated with all EOL subgroups. Moreover, pts with survival of ≤60 or ≤90 days were significantly associated with a lack of brain metastasectomy (p 0,034 and p 0.043) and with the lack of available post-BrRT systemic therapies deemed to improve survival (p 0.024 and p 0.046). No other factors, including the type of primary tumor or intrinsic brain metastasis features, were found to be significantly associated with EOL. Multivariate analysis showed that an ECOG score ≥2 (HR = 1.47; p 0.002) and the lack of brain metastasectomy (HR = 1.36; p 0.048) were significantly associated with survival. Conclusion: BrRT during EOL was shown to be commonly performed (in 44.94% of pts) for the treatment of brain metastasis. Consideration of pts’ performance status and whether they are candidates for brain metastasectomy or systemic therapies following BrRT may be key factors in the selection for BrRT.