A new updated prognostic index for patients with brain metastases (BMs) treated with palliative whole brain radiotherapy (WBRT) in the era of precision oncology. METASNCore project

• DOI: 10.1007/s11060-024-04618-1
• Publication Date: 2024-03-27T20:01:52Z
• Authors: Pablo Flores-Paco; Alicia Vargas-Aliaga; María Geraldina G...; Ignacio Lopera; Lucía Rodríguez Ruiz; María López-Herrero; Juan Adrián Camús; Javier López-Gonz...; Elizabeth Inga-Sa...; Marina Montero; Isidoro Barneto; Mª Auxiliadora Gó...; Estela Ruiz; Marta Ruza; Ana Armenta; Amalia Palacios; Juan R. De La Hab...; Enrique Aranda
• Keywords: Male; Adult; Aged, 80 and over; Brain Neoplasms; Palliative Care; Middle Aged; Prognosis; Survival Rate; Humans; Female; Cranial Irradiation; Precision Medicine; Retrospective Studies; Aged

Abstract Introduction Palliative WBRT is the main treatment for multiple BM. Recent studies report no benefit in survival after WBRT compared to palliative supportive care in patients (pts) with poor prognosis. A new era of systemic treatment strategies based on targeted therapies are improving the prognosis of patients with BM. The purpose of this study is to develop a prognostic score in palliative pts with BM who undergo WBRT in this new setting. Methods 239 pts with BM who received palliative WBRT between 2013–2022 in our center were analyzed retrospectively. The score was designed according to the value of the β coefficient of each variable with statistical significance in the multivariate model using Cox regression. Once the score was established, a comparison was performed according to Kaplan-Meier and was analyzed by log-rank test. Results: 149 pts (62.3%) were male and median (m) age was 60 years. 139 (58,2%) were lung cancer and 35 (14,6%) breast cancer. All patients received 30Gys in 10 sessions. m overall survival (OS) was 3,74 months (ms). 37 pts (15,5%) had a specific target mutation. We found that 62 pts were in group < 4 points with mOS 6,89ms (CI 95% 3,18 − 10,62), 84 in group 4–7 points with mOS 4,01ms (CI 95% 3,40 − 4,62) and 92 pts in group > 7 points with mOS 2,72ms (CI 95% 1,93 − 3,52) (p < 0,001). Conclusions: METASNCore items are associated with OS and they could be useful to select palliative pts to receive WBRT. More studies are necessary to corroborate our findings.