Multi-disciplinary management for patients with oligometastases to the brain: results of a 5 year cohort study
Session type: Poster / e-Poster / Silent Theatre session
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.
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.
- 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.
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.