Best supportive care in patients with brain metastases: impact of the primary tumour type on survival

Introduction
The study was aimed to analyse the impact of the tumour type and other patient- and disease-related baseline parameters in a consecutive cohort managed with best supportive care (BSC) in northern Norway.

Material and methods
This is a retrospective analysis of 149 patients managed with BSC without any systemic cancer-directed therapy or local brain-directed measures (2007–2024). Eleven patients were originally supposed to start active treatment and 12 had received prior prophylactic whole-brain irradiation (WBRT). Uni- and multivariate analyses of prognostic factors for survival were performed.

Results
Median survival after radiological diagnosis was 1.3 months (95% CI: 1.08–1.52) for all 149 patients combined. The 3- and 6-month survival rates were 20% and 1%, respectively. Neither prior WBRT nor upfront intention to treat were associated with survival. Steroid responders survived significantly longer than non-responders. The multivariate Cox model suggested that survival mainly depends on Karnofsky performance status (< 70 vs. ≥ 70), extracranial metastases (present/absent), and primary tumour type (better in renal cell cancer/malignant melanoma vs. all others combined), p ≤ 0.01 for all three predictors of survival.

Conclusions
All prognostic strata in our study had median survival times < 2.5 months, indicating an inevitable poor outcome, despite presence of statistically significant differences, e.g. for the primary tumour type. The clinical impact of prognostic scores would thus be very limited. Median survival was similar in historical studies of BSC. Best supportive care is a reasonable choice in patients with brain metastases and very short life expectancy, as also evident from prospective research.