title: Poor outcomes after whole brain radiotherapy in patients with brain metastases: results from an international multicentre cohort study.
abstract: OBJECTIVE
  To describe the characteristics and outcomes of cancer patients receiving Whole Brain Radiotherapy (WBRT) and delineate poor outcome groups after WBRT.
  
  
  METHODS
  From 1991 to 2007, 3459 patients receiving WBRT for brain metastases at three centres (in Australia and the Netherlands) were retrospectively reviewed. The effect of clinicodemographic factors, including age, gender, primary cancer, time to WBRT from primary cancer diagnosis and WBRT timing relative to other radiotherapy courses on overall survival, survival from WBRT commencement (WBRT-SV) and death within 6 weeks were analysed.
  
  
  RESULTS
  WBRT was the first radiotherapy course in 2161/3459 (63%) and the last in 2932/3459 (85%). The most common primary cancer sites with brain metastases were lung (n = 1800; 52%), breast (n = 568; 16%), melanoma (n = 350; 10%) and colorectal (n = 209; 6%). The median time to WBRT from primary cancer diagnosis was 34 weeks, overall survival 1.42 years (0.04-28.70) and WBRT-SV 0.33 years (0-8.60). Older age, male gender and a shorter time from the primary cancer diagnosis to WBRT predicted worse overall survival and WBRT-SV. Seventeen per cent survived less than 6 weeks. Older patients with a shorter time from the primary cancer diagnosis to WBRT and a lower WBRT episode number were more likely to die less than 6 weeks after WBRT.
  
  
  CONCLUSIONS
  Cancer patients with brain metastases have poor overall outcomes. High mortality within 6 weeks of starting WBRT suggests patient selection remains challenging.
authors.affiliation: Collaboration for Cancer Outcomes Research and Evaluation (CCORE), Liverpool Hospital, New South Wales, Australia; Department of Radiation Oncology, Liverpool Hospital, Liverpool, New South Wales, Australia; University of New South Wales, New South Wales, Australia. Electronic address: Apsara.Windsor@health.nsw.gov.au.
authors.forename: A A
authors.initials: AA
authors.lastname: Windsor
authors.forename: E-S
authors.initials: ES
authors.lastname: Koh
authors.forename: S
authors.initials: S
authors.lastname: Allen
authors.forename: G S
authors.initials: GS
authors.lastname: Gabriel
authors.forename: A E T
authors.initials: AE
authors.lastname: Yeo
authors.forename: R
authors.initials: R
authors.lastname: Allison
authors.forename: Y M
authors.initials: YM
authors.lastname: van der Linden
authors.forename: M B
authors.initials: MB
authors.lastname: Barton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
keywords: Brain; neoplasm; neoplasm metastasis; outcomes; radiotherapy