Long-term survival in patients with brain metastases

Purpose: The aims of this study are: (a) to determine long-term survival in patients with brain metastases who underwent whole brain radiation therapy; (b) to evaluate whether long-term survival can be predicted by the Radiation Therapy Oncology Group (RTOG) recursive partitioning analysis (RPA); and (c) to review the literature on long-term survival. Material and methods: The records of 916 patients with brain metastases who underwent whole brain radiation therapy at our hospital from 1985 to 2000 were analyzed retrospectively. Results: By July 2001, 891 patients had died. Median survival of the whole group was 3.4 months. Overall survival was 5.6% at 2 years (at risk: n=48), 2.9% at 3 years (n=25), 1.8% at 5 years (n=12), and <1% at 10 years (n=1). Survival for 2 years or more was observed in RTOG RPA class 1, but also in class 2 patients. Within both classes, survival was significantly better for patients with a single brain metastasis compared with those patients having multiple metastases. A survey of the literature revealed that in rare instances survival of 10 years or more was seen in patients with brain metastases. The majority of these patients had a single brain metastasis treated by radical resection and whole brain radiation therapy. Conclusion: Even in patients with favorable characteristics, survival for 2 years or more after the diagnosis of brain metastases is considerably low. Aggressive therapy in RPA class I and class 2 patients with a single brain metastasis occasionally permits long-term survival.