Email updates

Keep up to date with the latest news and content from Radiation Oncology and BioMed Central.

Open Access Research

Multi-disciplinary management for patients with oligometastases to the brain: results of a 5 year cohort study

Jillian Maclean1*, Naomi Fersht1, Mausam Singhera1, Paul Mulholland2, Orla McKee3, Neil Kitchen4 and Susan C Short15

Author Affiliations

1 Department of Radiotherapy, University College London Hospital, Euston Road, London NW12BU, UK

2 Department of Medical Oncology, University College London Hospital, Euston Road, London NW12BU, UK

3 Brain Tumour Unit, National Hospital for Neurology and Neurosurgery, Queen’s Square, London NC1N3BG, UK

4 Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, Queen’s Square, London NC1N3BG, UK

5 Leeds Institute of Molecular Medicine, St James University Hospital, Beckett St, Leeds LS97TF, UK

For all author emails, please log on.

Radiation Oncology 2013, 8:156  doi:10.1186/1748-717X-8-156

Published: 27 June 2013

Abstract

Background

The incidence of oligometastases to the brain in good performance status patients is increasing due to improvements in systemic therapy and MRI screening, but specific management pathways are often lacking.

Methods

We established a multi-disciplinary brain metastases clinic with specific referral guidelines and standard follow-up for good prognosis patients with the view that improving the process of care may improve outcomes. We evaluated patient demographic and outcome data for patients first seen between February 2007 and November 2011.

Results

The clinic was feasible to run and referrals were appropriate. 87% of patients referred received a localised therapy during their treatment course. 114 patients were seen and patient numbers increased during the 5 years that the clinic has been running as relationships between clinicians were developed. Median follow-up for those still alive was 23.1 months (6.1-79.1 months). Primary treatments were: surgery alone 52%, surgery plus whole brain radiotherapy (WBRT) 9%, radiosurgery 14%, WBRT alone 23%, supportive care 2%. 43% received subsequent treatment for brain metastases. 25%, 11% and 15% respectively developed local neurological progression only, new brain metastases only or both. Median overall survival following brain metastases diagnosis was 16.0 months (range 1–79.1 months). Breast (32%) and NSCLC (26%) were the most common primary tumours with median survivals of 26 and 16.9 months respectively (HR 0.6, p=0.07). Overall one year survival was 55% and two year survival 31.5%. 85 patients died of whom 37 (44%) had a neurological death.

Conclusion

Careful patient selection and multi-disciplinary management identifies a subset of patients with oligometastatic brain disease who benefit from aggressive local treatment. A dedicated joint neurosurgical/ neuro-oncology clinic for such patients is feasible and effective. It also offers the opportunity to better define management strategies and further research in this field. Consideration should be given to defining specific management pathways for these patients within general oncology practice.

Keywords:
Brain; Oligometastases; Multidisciplinary specialist clinic