Palliation of Brain Metastases: Analysis of Prognostic Factors Affecting Overall Survival.

Context: Brain metastasis is one of the most feared complications of cancer that poses significant mortality and morbidity in patients with advanced cancer. The incidence is rising because of greater use of magnetic resonance imaging and spectroscopy; and increased survival from recent advances in immunotherapy and modern radiotherapy techniques. Despite all, the prognosis remains poor.

Aims: This study aimed to analyze prognostic factors and overall survival in patients with brain metastases.

Subjects and Methods: A total of 145 patients were analyzed from July 2014 to June 2015 for various prognostic factors prospectively. Survival analysis was done using Kaplan-Meier curve.

Results: The median overall survival was 6 months, while 1- and 2-year survival rates were 8.3% and 1.4%, respectively. Median survival was highest with surgery followed by radiotherapy (11 months). Whole-brain radiotherapy (WBRT) significantly improved the survival ( P = 0.006). The most common primary was lung cancer (58%) and the most common histology was adenocarcinoma (36%). Most patients (38%) were diagnosed upfront with brain metastases. Most of the lesions were multiple (80%) and located in cerebrum (58%). Survival was significantly improved with female gender ( P = 0.003), Eastern Cooperative Oncology Group performance status (PS) 0-2 ( P = 0.006), breast primary ( P = 0.004), time lag of >6 months ( P < 0.001), solitary lesion ( P = 0.002), and controlled primary ( P = 0.017).

Conclusions: WBRT remains the cornerstone of the management of brain metastases. The present study concludes that the survival of patients with brain metastases is significantly improved with female gender, good PS, primary breast cancer, time lag of >6 months between diagnosis of the primary tumor and development of brain metastases, solitary lesion, and controlled primary tumor.