Multi-disciplinary management for patients with oligometastases to the brain: results of a 5 year cohort study


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Jillian Maclean1, Naomi Fersht1, M Singhera1, Paul Mulholland1, Orla McKee1, Neil Kitchen1, Susan Short1
1University College London Hospitals NHS Foundation Trust, London, UK

Background

The incidence of oligometastases in good performance status patients is increasing due to improvements in systemic therapy and the use of MRI screening. We present data from a 5-year cohort of patients selected for treatment within a multi-disciplinary clinic aimed at optimising local control of oligometastatic brain disease.

Method

A multi-disciplinary brain metastases clinic was established with specific referral guidelines and standard follow-up for good prognosis patients. Demographic and outcome data were collected on this cohort retrospectively between February 2007 and May 2012 from hospital and GP records.

Results

  • 114 patients were seen. Median follow-up for those still alive was 23.1 months (6.1-79.1 months). 25% of referrals involved patients with brain metastases as the first cancer diagnosis. 63%, 19% and 18% had 1, 2-3 and ≥4 brain metastases respectively. 83% had controlled primary tumour, 58% had controlled extracerebral metastases.
  • Primary treatment was surgery in 62%, (including 10 patients treated with surgery plus upfront whole brain radiotherapy (WBRT)), radiosurgery in 14%, WBRT in 23% and supportive care in 2%. 43% received subsequent treatment for brain metastases.
  • 52% of patients developed neurological progression: 25%, 11% and 15% developed local progression only, new brain metastases only or both respectively.
  • Median survival was 16.0 months from brain metastases diagnosis (range 1-79.1 months). Breast (32%) and NSCLC (26%) were the most common primary tumours with median survivals of 26 months and 16.9 months respectively (HR 0.6, p=0.07). Overall 1 year survival was 55% and 2 year survival 31.5%. 85 patients died of whom 37 (44%) had a neurological death.

Conclusion

Careful patient selection and multi-disciplinary management identifies a sub-set of patients with oligo-metastatic brain disease who benefit from aggressive local treatment and may survive 2 years or more. Consideration should be given to defining specific management pathways for these patients within general oncology practice.