Whole-brain radiotherapy in non-small cell lung cancer patients with brain metastases unsuitable for stereotactic radiotherapy: outcomes and prognostic factors

Objective: To evaluate clinical outcomes of whole-brain radiotherapy (WBRT) and identify prognostic factors associated withoverall survival (OS) in non-small cell lung cancer (NSCLC) patients with brain metastases who were not candidates for stereotacticradiotherapy (SRT).Patients and Methods: In this retrospective study, 71 NSCLC patients with brain metastases who underwent WBRT were included.Clinical and treatment data were collected, and survival outcomes and prognostic factors were evaluated.Results: The median age was 65 years, and 78.9% of patients were male. Adenocarcinoma was the most common histological subtype(54.9%). A Karnofsky Performance Status (KPS) ≥80 was observed in 74.6% of patients. Brain metastases were synchronous in 64.8%of cases, and 32.4% of patients had isolated intracranial disease. The median OS and intracranial progression-free survival (iPFS)following WBRT were both 3 months (95% CI: 1.0–5.0 and 1.7–4.3, respectively). In multivariate analysis, independent predictors ofimproved OS included KPS ≥80 (HR=5.72), early radiologic response (HR=4.10), the use of immunotherapy or targeted agents as firstlinesystemic therapy (HR=5.26), and the presence of isolated brain metastasis (HR=4.53).Conclusion: These findings highlight key predictors of improved survival after WBRT and underscore its continued clinical relevancein carefully selected NSCLC patients ineligible for SRT.