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Radiotherapy for Brain Metastases in Southern Thailand: Workload, Treatment Pattern and Survival

  • Phungrassami, Temsak (Division of Therapeutic Radiology and Oncology, Songklanagarind Hospital) ;
  • Sriplung, Hutcha (Epidemiology Unit, Faculty of Medicine, Prince of Songkla University)
  • Published : 2015.03.09

Abstract

Purpose: To study the patient load, treatment pattern, survival outcome and its predictors in patients with brain metastases treated by radiotherapy. Materials and Methods: Data for patients with brain metastases treated by radiotherapy between 2003 and 2007 were collected from medical records, the hospital information system database, and a population-based tumor registry database until death or at least 5 years after treatment and retrospectively reviewed. Results: The number of treatments for brain metastases gradually increased from 48 in 2003 to 107 in 2007, with more than 70% from lung and breast cancers. The majority were treated with whole brain radiation of 30 Gy (3 Gy X 10 fractions) by cobalt-60 machine, using radiation alone. The overall median survival of the 418 patients was 3.9 months. Cohort analysis of relative survival after radiotherapy was as follows: 52% at 3 months, 18% at 1 year and 3% at 5 years in males; and 66% at 3 months, 26% at 1 year and 7% at 5 years in females. Multivariate analysis demonstrated that the patients treated with combined modalities had a better prognosis. Poor prognostic factors included primary cancer from the lung or gastrointestinal tract, emergency or urgent consultation, poor performance status (ECOG 3-4), and a hemoglobin level before treatment of less than 10 g/dl. Conclusions: This study identified an increasing trend of patient load with brain metastases. Possible over-treatment and under-treatment were demonstrated with a wide range of survival results. Practical prognostic scoring systems to assist in decision-making for optimal treatment of different patient groups is absolutely necessary; it is a key strategy for balancing good quality of care and patient load.

Keywords

Radiotherapy;cancer;brain metastases;survival;workload;Thailand

Acknowledgement

Supported by : Prince of Songkla University

References

  1. Chang EL, Wefel JS, Hess KR, et al (2009). Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol, 10, 1037-44. https://doi.org/10.1016/S1470-2045(09)70263-3
  2. Christian E, Adamietz IA, Willich N, Schafer U, Micke O (2008). Radiotherapy in oncological emergencies-final results of a patterns of care study in Germany, Austria and Switzerland. Acta Oncol, 47, 81-9. https://doi.org/10.1080/02841860701481554
  3. Danjoux C, Chow E, Drossos A, et al (2005). An innovative rapid response radiotherapy program to reduce waiting time for palliative radiotherapy. Support Care Cancer, 14, 38-43.
  4. Duan L, Zeng R, Yang KH, et al (2014). Whole brain radiotherapy combined with stereotactic radiotherapy versus stereotactic radiotherapy alone for brain metastases: a meta-analysis. Asian Pac J Cancer Prev, 15, 911-5. https://doi.org/10.7314/APJCP.2014.15.2.911
  5. Estabrook NC, Lutz ST, Johnson CS, Henderson MA (2013). Whole brain radiotherapy for poor prognosis patients with brain metastases: predictably poor results. J Support Oncol, 11, 190-5. https://doi.org/10.12788/j.suponc.0006
  6. Evans TG, Chowdhury AMR, Evans DB, et al (2012). Thailand's universal coverage scheme: achievements and challenges: an independent assessment of the first 10 years (2001-2010), Synthesis Report. Nonthaburi: Health Insurance System Research Office. Available from: http://www.hsri.or.th/sites/default/files/THailand UCS achievement andchallenges_0.pdf.
  7. Gaspar LE, Scott C, Murray K, Curran W (2000). Validation of the RTOG recursive partitioning analysis (RPA) classification for brain metastases. Int J Radiat Oncol Biol Phys, 47, 1001-6. https://doi.org/10.1016/S0360-3016(00)00547-2
  8. Gavrilovic IT, Posner JB (2005). Brain metastases: epidemiology and pathophysiology. J Neurooncol, 75, 5-14. https://doi.org/10.1007/s11060-004-8093-6
  9. Hart MG, Walker M, Dickinson H, Grant R (2005). Surgical resection and whole brain radiation therapy versus whole brain radiation therapy alone for single brain metastases. Cochrane Database Syst Rev, 32, 92.
  10. Holmberg O, McClean B (2003). A method of predicting workload and staffing level for radiotherapy treatment planning as plan complexity changes. Clin Oncol (R CollRadiol), 15, 359-63. https://doi.org/10.1016/S0936-6555(03)00159-6
  11. Khuhaprema T, Attasara P, Sriplung H, Wiangnon S, Sangrajrang S (2013). Cancer in Thailand Vol. VII, 2007-2009. Bangkok: Ministry of Public Health, Ministry of Education. Available from: http://www.nci.go.th/th/File_download/Nci Cancer Registry/Cancer in Thailand_VII.pdf.
  12. Khuhaprema T, Attasara P, Sriplung H, et al (2012). Cancer in Thailand Vol. VI, 2004-2006. Bangkok: Ministry of Public Health, Ministry of Education. Available from: http://www.nci.go.th/en/File_download/Nci Cancer Registry/Cancer in thailand.pdf.
  13. Kocher M, Soffietti R, Abacioglu U, et al (2011). Adjuvant wholebrain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952-26001 study. J Clin Oncol, 29,134-41. https://doi.org/10.1200/JCO.2010.30.1655
  14. Kong W, Jarvis CR, Sutton DS, Ding K, Mackillop WJ (2012). The use of palliative whole brain radiotherapy in the management of brain metastases. Clin Oncol (R CollRadiol), 24, e149-58. https://doi.org/10.1016/j.clon.2012.08.004
  15. Langley RE, Stephens RJ, Nankivell M, et al (2013). Interim data from the Medical Research Council QUARTZ Trial: does whole brain radiotherapy affect the survival and quality of life of patients with brain metastases from non-small cell lung cancer? Clin Oncol (R CollRadiol), 25, e23-30. https://doi.org/10.1016/j.clon.2012.11.002
  16. Mitera G, Swaminath A, Wong S, et al (2009). Radiotherapy for oncologic emergencies on weekends: examining reasons for treatment and patterns of practice at a Canadian cancer centre. Curr Oncol, 16, 55-60.
  17. Nguyen T, Deangelis LM (2004). Treatment of brain metastases. J Support Oncol, 2, 405-16.
  18. Nieder C, Norum J, Dalhaug A, Aandahl G, Pawinski A (2013). Radiotherapy versus best supportive care in patients with brain metastases and adverse prognostic factors. Clin Exp Metastasis, 30, 723-9. https://doi.org/10.1007/s10585-013-9573-x
  19. Patil CG, Pricola K, Sarmiento JM, et al (2012). Whole brain radiation therapy (WBRT) alone versus WBRT and radiosurgery for the treatment of brain metastases. Cochrane Database Syst Rev, 61, 21.
  20. Pease NJ, Edwards A, Moss LJ (2005). Effectiveness of whole brain radiotherapy in the treatment of brain metastases: a systematic review. Palliat Med, 19, 288-99. https://doi.org/10.1191/0269216305pm1017oa
  21. Phungrassami T, Funsian A, Sriplung H (2013). 30 years of radiotherapy service in Southern Thailand: workload vs resources. Asian Pac J Cancer Prev, 14, 7743-8. https://doi.org/10.7314/APJCP.2013.14.12.7743
  22. R Core Team (2013). R: A Language and environment for statistical computing. Vienna, Austria, R Foundation For Statistical Computing.
  23. Rades D, Dziggel L, Nagy V, et al (2013). A new survival score for patients with brain metastases who received whole-brain radiotherapy (WBRT) alone. Radiother Oncol, 108, 123-7. https://doi.org/10.1016/j.radonc.2013.06.009
  24. Rodrigues G, Eppinga W, Lagerwaard F, et al (2012). A pooled analysis of arc-based image-guided simultaneous integrated boost radiation therapy for oligometastatic brain metastases. Radiother Oncol, 102, 180-6. https://doi.org/10.1016/j.radonc.2011.05.032
  25. Rodrigues G, Gonzalez-Maldonado S, Bauman G, Senan S, Lagerwaard F (2013). A statistical comparison of prognostic index systems for brain metastases after stereotactic radiosurgery or fractionated stereotactic radiation therapy. Clin Oncol (R CollRadiol), 25, 227-35. https://doi.org/10.1016/j.clon.2012.11.006
  26. Ryken TC, McDermott M, Robinson PD, et al (2010). The role of steroids in the management of brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol, 96, 103-14. https://doi.org/10.1007/s11060-009-0057-4
  27. Sabater S, Mur E, Muller K, Arenas M (2012). Predicting compliance and survival in palliative whole-brain radiotherapy for brain metastases. Clin Transl Oncol, 14, 43-9. https://doi.org/10.1007/s12094-012-0760-z
  28. Soffietti R, Kocher M, Abacioglu UM, et al (2013). A European Organisation for Research and Treatment of Cancer phase III trial of adjuvant whole-brain radiotherapy versus observation in patients with one to three brain metastases from solid tumors after surgical resection or radiosurgery: quality-oflife results. J Clin Oncol, 31, 65-72. https://doi.org/10.1200/JCO.2011.41.0639
  29. Soon YY, Tham IW, Lim KH, Koh WY, Lu JJ (2014). Surgery or radiosurgery plus whole brain radiotherapy versus surgery or radiosurgery alone for brain metastases. Cochrane Database Syst Rev, 94, 54.
  30. Sperduto PW, Berkey B, Gaspar LE, Mehta M, Curran W (2008). A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1,960 patients in the RTOG database. Int J Radiat Oncol Biol Phys, 70, 510-4. https://doi.org/10.1016/j.ijrobp.2007.06.074
  31. Sperduto PW, Chao ST, Sneed PK, et al (2010). Diagnosisspecific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multiinstitutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys, 77, 655-61. https://doi.org/10.1016/j.ijrobp.2009.08.025
  32. Sriplung H, Sontipong S, Martin N, et al (2003). Cancer in Thailand Vol. III, 1995-1997. Bangkok: Bangkok Medical Publisher.
  33. Stavas M, Arneson K, Friedman J, Misra S (2014). From whole brain to hospice: patterns of care in radiation oncology. J Palliat Med, 17, 662-6. https://doi.org/10.1089/jpm.2013.0549
  34. Summers E, Williams M (2005). Re-audit of Radiotherapy Waiting Times. London: The Royal College of Radiologists. Available from: https://www.rcr.ac.uk/docs/general/pdf/RTWT2005report.pdf
  35. Thai Society of Therapeutic Radiology and Oncology (2012). Services, manpower and equipments in Thailand radiotherapy centers 2011.
  36. Tsao M (2013). Brain Metastases. In 'Radiation Oncology in Palliative Cancer Care', Eds Lutz S, Chow E, Hoskin P. John Wiley & Sons, pp. 270-82.
  37. Tsao M, Xu W, Sahgal A (2012). A meta-analysis evaluating stereotactic radiosurgery, whole-brain radiotherapy, or both for patients presenting with a limited number of brain metastases. Cancer, 118, 2486-93. https://doi.org/10.1002/cncr.26515
  38. Tsao MN, Lloyd N, Wong RK, et al (2012). Whole brain radiotherapy for the treatment of newly diagnosed multiple brain metastases. Cochrane Database Syst Rev, 38, 69.
  39. Tsao MN, Rades D, Wirth A, et al (2012). International practice survey on the management of brain metastases: third international consensus workshop on palliative radiotherapy and symptom control. Clin Oncol (R CollRadiol), 24, e81-92. https://doi.org/10.1016/j.clon.2012.03.008
  40. Virani S, Sriplung H, Rozek LS, Meza R (2014). Escalating burden of breast cancer in southern Thailand: analysis of 1990-2010 incidence and prediction of future trends. Cancer Epidemiol, 38, 235-43. https://doi.org/10.1016/j.canep.2014.03.003
  41. Weltman E, Salvajoli JV, Brandt RA, et al (2000). Radiosurgery for brain metastases: a score index for predicting prognosis. Int J Radiat Oncol Biol Phys, 46, 1155-61. https://doi.org/10.1016/S0360-3016(99)00549-0
  42. Windsor AA, Koh ES, Allen S, et al (2013). Poor outcomes after whole brain radiotherapy in patients with brain metastases: results from an international multicentre cohort study. Clin Oncol (R CollRadiol), 25, 674-80. https://doi.org/10.1016/j.clon.2013.07.002

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