Palliative Care

PD 02 - Palliative 1 - Poster Discussion

1011 - Whole Brain Radiation Therapy Use Among Metastatic Non-Small Cell Lung Cancer Patients

Sunday, October 21
1:27 PM - 1:33 PM
Location: Room 217 C/D

Whole Brain Radiation Therapy Use Among Metastatic Non-Small Cell Lung Cancer Patients
S. E. Rich1, J. R. Robbins2, K. V. Dharmarajan3, O. K. Rahman4, and C. Johnstone2; 1Haven Hospice, Gainesville, FL, 2Medical College of Wisconsin, Milwaukee, WI, 3Icahn School of Medicine at Mount Sinai Department of Radiation Oncology, New York City, NY, 4Icahn School of Medicine at Mount Sinai Brookdale Department of Geriatrics and Palliative Medicine, New York, NY

Purpose/Objective(s): To evaluate the use of whole brain radiation therapy (WBRT) among patients with non-small cell lung cancer (NSCLC) and brain metastases, with a focus on survival and length of treatment.

Materials/Methods: We included 42,327 NSCLC patients with brain metastases at initial diagnosis in the National Cancer Database (NCDB) from 2010-2013. We excluded patients who did not have information about radiation or those who received stereotactic radiosurgery, patients who received dose-fractionations incompatible with WBRT, and patients with no follow-up. We examined WBRT schedules, survival following WBRT, rates of completion of WBRT, and the percentage of remaining life spent receiving WBRT (PRLSRT), calculated as elapsed days of WBRT/days from start of WBRT to death.

Results: Among NSCLC patients with brain metastases at diagnosis, 35.0% received WBRT (n=14,810). The most common fractionation schedules were 3 Gray/fraction for 10 fractions (60.6%, n=7,533) and 2.5 Gray/fraction for 14 or 15 fractions (36.3%, n=4,514). Only 84% of patients who started WBRT completed it. Patients were more likely prematurely terminate the course if they were prescribed courses greater than 10 days in duration. Median survival from diagnosis among the patients receiving WBRT was 4.83 months (95% confidence interval 4.70-4.96 months). Fourteen percent of patients died within 30 days of starting WBRT (n=2,078), and 36% of patients died within 60 days of completing WBRT (assuming a typical 10-fraction course, n=5,331). Twenty-eight percent of patients spent at least one-quarter of their remaining life receiving WBRT, with 12% spending more than one-half of their remaining life receiving WBRT.

Conclusion: Survival among patients with metastatic NSCLC to the brain at diagnosis is usually short, and WBRT often occupies a substantial portion of their remaining life. Shorter courses of WBRT or supportive care alone are more appropriate in this population.

Author Disclosure: S.E. Rich: None. J.R. Robbins: Travel Expenses; Elekta. K.V. Dharmarajan: None. C. Johnstone: Employee; Medical College of WI.

Shayna Rich, MD, PhD

Disclosure:
Employment
Haven Hospice: Assistant Medical Director: Employee

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