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

Purpose: To study the patient load, treatment pattern, survival outcome and its predictors in patients withbrain metastases treated by radiotherapy. Materials and
Methods: Data for patients with brain metastasestreated by radiotherapy between 2003 and 2007 were collected from medical records, the hospital informationsystem database, and a population-based tumor registry database until death or at least 5 years after treatmentand retrospectively reviewed.
Results: The number of treatments for brain metastases gradually increased from48 in 2003 to 107 in 2007, with more than 70% from lung and breast cancers. The majority were treated withwhole brain radiation of 30 Gy (3 Gy X 10 fractions) by cobalt-60 machine, using radiation alone. The overallmedian survival of the 418 patients was 3.9 months. Cohort analysis of relative survival after radiotherapy wasas 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 and7% at 5 years in females. Multivariate analysis demonstrated that the patients treated with combined modalitieshad 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 treatmentof 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. Practicalprognostic scoring systems to assist in decision-making for optimal treatment of different patient groups isabsolutely necessary; it is a key strategy for balancing good quality of care and patient load.