Prognostic Factors and Survival Outcome of Whole Brain Radiotherapy in Metastatic Brain Cancer- A Single Regional Cancer Centre Experience in North India

BACKGROUND Brain metastasis is the leading cause of mortality and morbidity and is the most common intracranial neoplasm in adults. Once the brain metastasis develops, treatment remains only palliative with an intention to improve the quality of life. Whole brain radiotherapy is the palliative treatment offered to such patients at our institute. This study is the first of its kind in Northern India which aims to determine the survival after whole brain radiotherapy and prognostic factors of brain metastasis from solid tumors. METHODS This is a retrospective study conducted at a tertiary cancer centre in Northern India treated over a period of 5 years from 2014 to 2018. The data was collected from the hospital database and details of treatment and patient characteristics were collected from patient's treatment charts. The data was entered into Microsoft Office Excel 2007 and analysed with the help of SPSS Ver. 20. RESULTS Median survival was found to be 3.7 months (0.03 to 21.9 months). On univariate analysis, median survival was found to be significantly higher among patients with less than three brain mets (p=0.003), size of brain mets less than 3 cms (p=0.005) and dose of radiotherapy more than or equal to 30 Gy (p=0.001). On multivariate analysis also, the number of BM, size of BM and dose of radiotherapy were found to be significant predictors of overall survival. CONCLUSIONS Though whole brain radiotherapy improves survival in such patients, the benefit offered is small. Based on prognostic factors, we can identify such group of patients who may just be offered best supportive care. This may decrease the palliative workload in a limited resource setting like ours. This result must be interpreted with caution since the administration of steroids was not controlled in the present study.