Predicting Early Mortality After Whole-Brain Radiotherapy in Metastatic NSCLC to Support Patient-Centred Decision-Making

Background: This study sought to evaluate 30- and 60-day mortality following palliative whole-brain radiotherapy (WBRT) in patients with metastatic non-small cell lung cancer (NSCLC), and to identify readily accessible clinical predictors to guide therapeutic decisions. Methods: This retrospective single-centre study analyzed 392 patients treated with WBRT. Pretreatment factors were assessed using multivariable Cox regression and translated into the six-point Bedside Early Mortality Score (BEMS). The score’s ability to predict mortality within 30 and 60 days of WBRT completion was evaluated using receiver operating characteristic (ROC) analysis and compared with Lung-specific Graded Prognostic Assessment (Lung GPA) and Recursive Partitioning Analysis (RPA). Results: Overall, 115 patients (29.3%) died within 30 days and 178 (45.4%) within 60 days. The score included four parameters readily available during bedside consultation: age ≥65 years, direct inpatient transfer, and abnormal mental status at initiation of WBRT each contributed one point, while impaired mobility contributed three points. Each additional point increased the risk of mortality by 55% (HR 1.55, 95% CI 1.46–1.64). Thirty- and sixty-day mortality according to score were, respectively, 2.2% and 8.5% (0–1 points), 10% and 36.7% (2–3 points), 57.8% and 85.7% (4–5 points), and 85.8% and 90.5% (6 points). Areas under the ROC curve for 30- and 60- day mortality were 0.855 and 0.881, compared with 0.685 and 0.740 for Lung GPA and 0.833 and 0.899 for RPA. Conclusions: The Bedside Early Mortality Score may complement clinical evaluation and support shared decision making in WBRT. Independent validation is required.