152 - Whole brain radiotherapy in metastatic non-small cell lung cancer: an audit of current practice

Introduction: Whole brain radiotherapy (WBRT) has traditionally
been the treatment of choice in patients with brain metastasis (BM)
from non-small cell lung cancer (NSCLC). The aim of this study was
to audit the current practice of WBRT following the publication of
the QUARTZ trial [1].
Methods: NSCLC patients with BM referred to our organisation
between 01/2016 and 07/2016 were identified from electronic
records. Patient demographics, treatment details and prognostic
factors were collected. Radiotherapy data was obtained from
MOSAIQ® software. Overall survival time was calculated and IBMSPSS
statistical software was used to formulate Kaplan-Meier
survival curves and perform cox-regression analysis.
Results: 693 patients were identified. 46 patients presented with
or developed BM. 25 out of 46 patients received WBRT (54%), of
which 16 were female (64%) and 18 were ≤65 years (72%). In patients
treated with WBRT, performance status was ECOG 0–1 in 16 patients
(64%) and 2–3 in 9 patients (36%). 9 patients with BM were found
to have an EGFR or ALK positive driver mutation (19.6%), of which 6
had WBRT (66.7%). 2 out of 9 (22.2%) patients with driver mutations
were classified as RPA class I and 7 out of 9 (77.7%) RPA class II. 30Gy
in 10 fractions was delivered in 20 out of 25 (80%) patients and all
patients with driver mutations. There was no significant difference
in median survival between patients with brain metastases who
received WBRT and those who did not (6.8 months vs 3.8 months,
p=0.096). 16 patients aged 56 to 65 years received WRBT and had
significantly longer survival than the older patients, aged ≥76 years
(11 months vs 2.8 months, p=0.023).
Conclusion: WBRT is used in routine practice. However, in our
institution its use tends to be reserved for younger patients and/or
those with a driver mutation.