Survival following whole brain radiation treatment for cerebral metastases: an audit of 474 patients

Background and purpose: To report the outcome of patients with brain metastases from solid tumors treated with whole brain radiotherapy (WBRT) in a single institution. Given the high proportion of melanoma patients, a secondary aim was to compare our outcomes for patients with melanoma to those with other cancers. Patients and methods: A retrospective audit identified 474 patients treated between January 1983 and December 1999. Survival was calculated using the Kaplan-Meier method. Cox regression modeling was used for multivariate analysis. Results: Four hundred and fifty nine patients have died from their disease. The median survival was 4.1 months for the whole group and 3.6 months for the 42% of patients with melanoma. The 1 and 2 year survival was 15 and 5%. Six patients lived beyond 5 years. 105 of 186 patients with a single brain metastasis underwent surgery plus WBRT, and 81 received WBRT alone. Median survival was 8 and 4 months, respectively, (P < 0.0001). 30 Gy in 10 fractions was used more commonly in the early part of the study compared to 20 Gy in 5 fractions more recently. There was no difference in survival by time period. Conclusions: The survival in this series was comparable to other studies. Performance status, resection, dose, and the presence of extra cranial disease appeared to be significant prognostic factors. The survival for the large number of patients with melanoma did not differ from the rest of the cohort. (C) 2004 Elsevier Ireland Ltd. All rights reserved.