Assessing Accuracy of Estimating Patient Survival in a New Radiosurgery Service Offered in a Geographically Isolated Area


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Karen Thompson, Hn Simms, Peter Crossley

Abstract

Background

Stereotactic radiosurgery (SRS) is a new treatment modality offered in Northern Ireland, having commenced in 2017.  This new service avoids the inconvenience of travelling to Mainland UK for the treatment.  This study aims to compare the predicted life expectancy (PLE) and actual survival time of patients who have received SRS.

Method

All patients who underwent SRS for brain metastases between May 2017 and December 2018 in the region, and who also met inclusion criteria (sufficient documentation of predicted and actual survival times), were included in the study.  Whilst 34 patients underwent SRS within this time period, only 17 had a documented PLE outlined prior to treatment commencement, and therefore the study focused only on these patients.  The key data about these patients – namely the predicted survival time, actual survival time, type of primary tumour, ECOG status and number of brain metastases – was obtained via our Electronic Care Records.

Results

41.2% of the patients met or exceeded their PLE.  Within the limitations of the small sample size, the following information was ascertained.  Patients with renal cell carcinoma more frequently met or exceeded their PLE (66.7%), in comparison to other primary tumours, such as small cell lung cancer (20%).  Those with ECOG scores 0-1 demonstrated higher likelihood of meeting PLE than those with ECOG scores 2-3 (50% v 28.5%).  More patients with ≥2 brain metastases met their PLE (66.7%), in comparison to those with a single brain metastasis (27.3%).  Patient age was also relevant to the accuracy of PLE; the mean age of those that met their PLE was 55 years, whereas the mean age of those who did not was 67 years.

Conclusion

This study has demonstrated that whilst PLE is an important factor to consider when making treatment decisions within the neuro-oncology field, it is a challenging concept to predict accurately.  The trends identified will be useful in highlighting areas where over-estimation of PLE may be more likely.  It is useful to gain insight into the outcomes of service users of this new treatment option in this geographical region. 

Impact statement

This study allows insight into patient survival following new treatment option in Northern Ireland.