THE PATTERNS OF REFERRAL FOR PATIENTS WITH BRAIN METASTASES TO THE NEURO-ONCOLOGY MDT

Abstract AIMS 20.0-40.0% of patients with cancer will develop brain metastases (BM). This study aims to demonstrate the numbers, demographics and outcomes of patients referred for brain metastases to a university hospital Neuro- oncology MDT in 2013 vs 2021. METHODS All adult patients referred to the Neuro-oncology MDT in 2013 and 2021, with histopathological or radiologically- suspected diagnosis of intrinsic BM were included. Data collection from electronic records and Synapse. Survival was compared using log-rank tests, and chi- squared test was used to assess differences in proportions. RESULTS BM referrals nearly doubled between 2013 and 2021 (94 vs 179 respectively). Lung cancer was the most common primary. The majority of patients had a solitary BM in 2013 (56.4%) and 2021 (43.0%). Fewer patients had a brain metastasis as their cancer-presenting problem in 2021 (p<0.01). Incidental diagnosis of BM was more common in 2021 (21.2%) compared to 2013 (5.3%). The proportion of patients undergoing surgery was not significantly different but there was a significant in- crease in SRS treatment (p<0.0001, 49.7% in 2021 vs 14.9% in 2013). Recurrent SRS was offered up to * 3 in 2013 (1 patient), and * 4 in 2021 (2 patients). There is a significant difference in survival between the different primary cancers in both 2013 and 2021. Me- dian overall survival for breast, melanoma, lung and GI cancers improved but only lung cancer survival was significantly better (median 4.6 vs 11.7 months respectively, p<0.0001). Overall, the median OS for whole cohort has significantly improved between 2013 and 2021 from 5.3 months to 11.4 months (p<0.0001). CONCLUSION With advances in primary cancer treatment, more patients are developing BM. More BM are found incidentally, possibly due to better imaging and screening. SRS is the most common treatment plan, and many are having re- current SRS treatments, putting an increasing demand on this service. Brain metastases survival has improved.