1. Brain Metastases: post-whole brain radiotherapy systemic treatment increases survival
Junliang Liu, M.D., M.Sc. Ph.D., FRCPC
Assistant Professor
University of Manitoba, CancerCare Manitoba, Canada

2. Study Purpose/Objective

3. Brain metastases (BM) account for more than one- half of all intracranial malignancies. The prognosis of cancer patients with BM has been dismal even with the availability of stereotactic radiosurgery (SRS), surgery, whole brain radiotherapy (WBRT) or the combination of these modalities. This study is to explore the impact of post-WBRT systemic treatment.

4. Material/Methods

5. A consecutive cohort of 65 patients with BM were identified
A consecutive cohort of 65 patients with BM were identified. The patients were treated with WBRT with daily treatment, five days per week:
30 Gy/12 Frs: n=27
30 Gy/10 Frs: n=25
20 Gy/5 Frs: n=11
24 Gy/8 Frs (planned for 30 Gy/10 Frs): n=1
15 Gy/5Frs (planned for 30 Gy/10 Frs): n=1

6. One patient with breast primary received SRS, 20Gyx1 to 50% iso-dose line, to 3 lesions. She was found with multiple new lesions 3 months later and substantial progression for the treated lesions 6.5 months later, then treated with WBRT Another patient with breast primary with diffuse BM received WBRT, 4 months later received SRS, Gyx1, to 5 lesions, 3 months after SRS her BM had mixed response, but extensive progression 4 months after SRS

7. Data was analyzed by dividing patients into group1 patients who received post-WBRT systemic treatment and group2 patients who did not have post-WBRT systemic treatment Statistic analysis was conducted by using Student t test

8. Results

9. Between July 1, 2005 to May 1, 2016, 65 patients, male 31, female 34, aged 25 to 92 years old were identified. Fifty six out of 65 patients had multiple brain lesions. Eleven out of 65 patients received post-WBRT systemic treatment including chemotherapy (9 out of 11 patients) and target therapy (3 out of 11 patients)

10. The median post-WBRT survival for patients who received post-WBRT systemic treatment was 13.5 months, compared to a much short median survival of only 3.0 months for patients who did not receive post-WBRT systemic treatment

11. Table 1. Patient Characteristics
Primary
Number of patients
Age (median)
Post-WBRT systemic therapy
Lung Cancer 37
45-84 (64) 7
Breast Cancer 13
25-92 (60) 2
Rectal Cancer 3
62-80
Colon Cancer
59-68
Stomach cancer
59-60
Endometrial Cancer
55-69
Ovarian Cancer
62-67 1
Unknown primary
34-70
Melanoma 57
Esophageal Cancer 64
Total 65
25-92 (63) 11

12. Table2. Summary of patients received post-WBRT systemic therapy
age
gender
primary
Extra- cranial disease
WBRT
Systemic therapy
Time of systemic therapy
Post- WBRT survival 1 74 m
lung
yes
30 Gy/10 fractions
Afatinib
30 days
16 alive 2 53
30 Gy/12 fractions
Carbo+Tax ol x4 cycles
60 days 7 3 61 f
Carbo+Ge mx4 cycles
74 days 18 4 63
30Gy/10 fractions
Carbo+Ge m, Erlotinib
150 days
13.5 5 57
melano ma
Dabrafenib
-14 days 6 62
ovarian
Caely, Carbo
145 days
21 alive

13. Table 2 continues 7 59 f lung yes 30 Gy/10 fractions
Carbo+Gem, Docetaxol
12 days 5 8 62 m
30 Gy/12 fractions
Carbo + Gem
37 dyas 22 9 61
170 days 14 10 72
breast
Xeloda
180 days
11.3 11 44
20 Gy/5 fractions
Capecitabine
5 days

14. Figure 1. Patient distribution according to the primary cancer

17. Side effects for patients received post-WBRT systemic therapy
Fatigue: 11/11 Alopecia: 11/11 Mild memory decease: 1/11 ( this 63 years old man presented with recurrence and abdominal plus brain metastases received post- WBRT chemo and erlotinib, passed away 13.5 months post-WBRT due to extra-cranial progression) Impaired hearing ability: 1/11 further decreased hearing ability on top of his pre-existing hearing disability. This 74 years old man presented with Stage IV NSCLC with spinal and BM. He has been on afatinib after WBRT and is alive 16 months after WBRT without evidence of cranial disease and no clear evidence of extra-cranial disease

18. Conclusion

19. Post-WBRT systemic treatment increases the overall survival of patients with brain metastases Systemic treatment with chemo and or target agents should be aggressively pursued

20. Thank you