Purpose/Objectives Improvements in systemic therapy have led to longer survival for patients with brain metastases (BM). While stereotactic radiosurgery (SRS) is favored for patients with limited BM, whole brain radiotherapy (WBRT) is still utilized in patients with higher number/volume of BM, high BM velocity, and leptomeningeal disease (LMD). However, limited data exist describing long-term patient outcomes following WBRT. Here we report quality of life and survival outcomes for patients receiving WBRT with long-term follow up (>3 months). Materials/Methods We retrospectively identified patients with BM at a single institution from 2016-2021 treated with WBRT and followed for at least 3 months with brain imaging. Patient demographics, oncologic history, and treatment details were collected. Descriptive statistics were performed. Kaplan-Meier survival analysis (with log-rank test for comparison between groups) was conducted for overall survival (OS) and intracranial progression-free survival (PFS). Results This study included 24 patients with median follow-up of 10.1 months (range 2.0-60.2 months), 25% of whom had prior SRS. At the time of WBRT, 50% of patients had 1-4 BM, 13% had 5-10 BM, 21% had greater than 10 BM, and 17% had LMD. The most common primary histologies included non-small cell lung cancer (NSCLC) (33%), breast cancer (29%,), and melanoma (17%). Most patients (67%) had progressing extracranial disease. 75% of patients received opposed lateral field WBRT, while 25% received hippocampal-sparing WBRT (with IMRT), and most patients (63%) were treated with 3000cGy in 10 fractions. Nearly all patients received memantine and systemic therapy after WBRT. Over half of patients had intracranial progression after WBRT: 46% developed new BM, 21% had local recurrence, and 13% developed LMD. Median intracranial PFS was 8.0 months (95% CI 3.1-12.9). Median OS for the cohort was 19.0 months (95% CI 13.3- 24.7). There were no significant differences in OS by histology, extracranial disease status, initial Karnofsky Performance Status (KPS), or extent of intracranial disease, although there was a trend toward better OS in patients with NSCLC and fewer initial BM. The median KPS for our cohort was 80 prior to WBRT (range 60-90) with a median KPS change of 0 (range -40-+30) at last follow up. Fatigue/cognitive symptoms were reported prior to WBRT in 21%/33% of patients, at any follow up in 58%/38% of patients, and at last follow up in 29%/17% of patients, respectively. Conclusion Within the limitations of a small retrospective cohort, long-term survivors following WBRT maintain performance status and appear to experience improvement in fatigue and cognitive symptoms that develop following WBRT. Additional studies characterizing longitudinal functional and neurological outcomes for these patients are needed, to optimize use of WBRT with increasing incidence of BM and newer cognitive-sparing techniques.
Rami Darawsheh (Sun,) studied this question.