1. Analysis of referral patterns and regional neuro-oncology multi-disciplinary team decisions in brain metastasis
Dr Kamalram THIPPU JAYAPRAKASH, Dr Javier GARCIA-CORBACHO, Dr Charles WILSON, Dr Richard BAIRD, Dr Sarah JEFFERIES
Cambridge Cancer Centre, Cambridge University Hospitals, Hills road, Cambridge, CB2 0QQ
Aim
To analyse referral patterns and management
decisions of a regional neuro-oncology
multi-disciplinary team meeting (MDM).
Content of presentation
A retrospective review of referral patterns, primary
tumours, number of metastasis and MDM decisions of
patients identified from MDM database between
January 2011 and December 2012 was conducted.
Relevance
The incidence of brain metastasis is increasing and
patients present through different routes. Their
management is complex and require MDM discussion.
Outcomes
243 patients were available for analysis. 63 % of the
referrals were from district general hospitals %
of patients had oligo- metastatic disease (one or two
metastases) % of metastases were in cerebral
hemispheres and lung, breast and lower gastro
intestine cancers were three common primaries.
45.7 % of patients were recommended for
neurosurgery, out of which 89.2 % had oligo-metastatic
disease, (90% of them had a single metastasis). Out of all patients with oligo-metastatic disease, only 54.7 % were recommended for surgery and further 5.5% for stereotactic radiotherapy treatment (Fig 1). Poor performance status, site and size of metastases, lack of full investigations were main reasons why the rest
were not recommended for these treatments. In the group with multiple metastases (Fig 2), 21.4 % of patients were recommended for surgery for obtaining histology and for palliation and 83.3% who were recommended, proceeded to surgery.
Discussion
There were a large number of referrals from district general hospitals to a regional neuro-oncology service.
89 % of patients for whom surgery was recommended had oligo-metastatic disease, 90% of them had single metastases. All patients with oligo-metastases should be considered for referral to MDM and consideration for clinical trials to advance the management of brain metastases. Patients with operable brain metastases may
be suitable for clinical trials. The Cambridge Brain Metastasis Trial 1 (CamBMT1) is testing whether drug delivery to operable brain metastases can be enhanced by low dose radiotherapy which may disrupt the
blood-brain-barrier (EudraCT ).
Fig 1.Oligo-metastases cohort (n = 181)
Fig 2. Multiple metastases cohort (n = 56)