Overall survival following whole-brain radiotherapy for brain and leptomeningeal metastases from solid tumors.

Abstract

Objectives: Brain and leptomeningeal metastases are relatively common complications of advanced solid tumors, occurring in an estimated 20%-40% of cases and significantly reducing survival and quality of life. Despite advancements in systemic therapies and stereotactic radiosurgery, whole-brain radiotherapy (WBRT) remains the standard treatment. This study evaluates overall survival (OS) and prognostic factors in patients with brain and leptomeningeal metastases treated with WBRT at a single institution.

Materials and methods: We retrospectively analyzed 228 patients with brain and leptomeningeal metastases treated with WBRT between December 2012 and April 2024. Patients received either 30 Gy in 10 fractions or 20 Gy in five fractions. Prognostic factors were assessed using multivariate Cox proportional hazards regression.

Results: The median OS for the entire cohort was 5.5 months (95% confidence interval: 3.8-6.2). Female patients had a statistically significantly longer OS (8.5 months) compared with male patients (3.8 months, P = 0.004). Better Eastern Cooperative Oncology Group (ECOG) performance status was strongly associated with improved survival (P < 0.001). The median OS of the 17 patients with leptomeningeal metastases was 5.7 months, which was not statistically different from that of patients without leptomeningeal metastases (5.1 months, P = 0.537). In multivariate analysis, sex (Hazard ratio [HR]: 0.682, P = 0.039) and performance status (HR: 2.357, P < 0.001) were identified as statistically significant prognostic factors.

Conclusion: This study confirms that WBRT offers modest survival benefits, consistent with prior research. While factors such as patient sex and ECOG performance status influence outcomes, the clinical impact of WBRT on leptomeningeal metastases remains limited. Survival outcomes are significantly impacted by factors such as patient sex and performance status, highlighting the need for personalized patient evaluation.