Oral Scientific Session
The Economic Implication of Upfront Whole-Brain Radiation Therapy for Patients With Limited Brain Metastasis

https://doi.org/10.1016/j.ijrobp.2016.06.393Get rights and content

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Purpose/Objective(s)

For patients with limited brain metastasis, the addition of upfront whole-brain radiation therapy (WBRT) to stereotactic radiosurgery (SRS) does not improve survival at the expense of cognitive decline in some patients. However, patients treated with SRS alone remain at greater risk for intracranial failure, which presumably increases health-related costs. We hypothesized that cancer-specific costs are similar between patients treated with upfront SRS alone and SRS + WBRT.

Materials/Methods

A retrospective cohort study of patients diagnosed with brain metastasis between 2009 and 2014 at a single tertiary care institution was conducted. Patients undergoing upfront WBRT alone were excluded. Costs were estimated from the payer’s perspective using Medicare cost-to-charge ratios. Total, cancer-specific, and brain metastasis-specific costs were collected through December 2015. The primary outcome was cumulative cancer-specific costs incurred following brain metastasis diagnosis.

Results

At presentation, 418 patients were diagnosed with 878 brain metastases: 74 patients (18%) underwent SRS +/- surgery + WBRT, while 344 patients (82%) underwent SRS +/- surgery. Median overall survival was similar between cohorts (14 vs. 13 months, P = 0.59), while 12-month distant intracranial failure was higher among those treated without WBRT (47% vs. 23%, P < 0.01). Salvage WBRT (0% vs. 22%) and SRS (11% vs. 26%, P < 0.01) were less common in the WBRT cohort. Cost data were collected for a

Conclusion

For patients with limited brain metastases, adjuvant WBRT improves intracranial control but does not translate to improved survival. Upfront SRS alone was as cost effective as upfront SRS + WBRT, and was not associated with increased brain metastasis-specific, cancer-specific, or total medical costs. Further studies are needed to confirm the cost-effectiveness of upfront SRS for patients with limited brain metastasis.

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Author Disclosure: J.A. Miller: None. R. Kotecha: None. A.M. Mohammadi: None. E.S. Murphy: None. J.H. Suh: Research Grant; Varian Medical Systems. Travel Expenses; Elekta. G.H. Barnett: None. M.A. Vogelbaum: Honoraria; Pharmacokinesis, Inc., Neuralstem, Inc. Stock; Infuseon Therapeutics. Royalty; Infuseon Therapeutics. L. Angelov: None. M. Ahluwalia: Research Grant; Elekta, Boehringer Ingelheim, Bristol-Myers Squibb, Novartis, Spectrum Pharmaceuticals, Tracon Pharmaceuticals, Novocure. Consultant; Merck, Genentech/Roche, Incyte Corporation, Caris Lifesciences, Monteris Medical, MRI Interventions, Inc. S.T. Chao: Consultant; Varian Medical Systems.

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