Abstract
Objective
Tumors that metastasize to the brain are associated with poor survival and tend to recur at the original site after treatment. Adjuvant whole brain radiation therapy (WBRT) is recommended after surgical resection in order to decrease recurrence rates. However, prognostic factors that determine which patients may benefit from WBRT remain limited. We set out to characterize our experience with WBRT in these patients and identify prognostic factors.
Methods
Ninety-eight patients who underwent surgical resection for metastatic brain tumors were identified by retrospective chart review. Demographic data was collected, patient survival and tumor recurrence rate after treatment were assessed using the Kaplan-Meier analysis and the Cox-proportional hazard regression while controlling for confounders.
Results
Median overall patient survival was 175 days. There was tumor recurrence in 17 cases and median time to recurrence was 148.5 days. Adjuvant WBRT was significantly associated with increased patient survival (p = 0.04) and decreased tumor recurrence (p = 0.01). Increased patient survival was also associated with the presence of salvage radiation, the Karnofsky performance score (KPS) of equal to or greater than 70, and supratentorial metastases. Decreased survival was associated with lesions of the temporal lobe and presence of extra-cranial metastases. Increased tumor recurrence rate was associated with the presence of salvage radiation, the presence of prophylactic radiation, and lesions of the occipital lobe.
Conclusion
We found that adjuvant whole brain radiation was associated with decreased tumor recurrence and longer survival in our patient cohort. Location of the metastasis influenced recurrence and survival. Also, patients receiving prophylactic radiation may harbor tumors more prone to recur.
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