Brain metastases (BM) occur in about 30% of all patients with non-small cell lung cancer (NSCLC). BM treatment guidelines recommend more frequent use of stereotactic radiotherapy (SRT). Overall, st...

Up to 40% of non-smallcell lung cancer (NSCLC) patients develop brain metastases (BMs). The potential benefits of radiotherapy (RT) in patients with poor performance status (PS) are questionable, with considerable risk for futile treatment. We analyzed overall survival after initial radiotherapy in NSCLC patients with BMs, focusing on the relationship between PS and survival after RT. This study reports a prospective observational study including consecutive 294 NSCLC patients with first-time BMs. Overall survival (OS) was calculated from the start of RT to death or last follow-up (1 June 2023). Overall, in the 294 included patients (median age 69 years), the median OS was 4.6 months; 2.5 months after WBRT (n = 141), and 7.5 months after SRT (n = 153). After WBRT, mOS was equally poor for patients with ECOG 2 (1.9 months) and ECOG 3–4 (1.2 months). After SRT, mOS for patients with ECOG 2 was 4.1 months; for ECOG 3 patients, mOS was 4 1.6 months. For NSCLC patients with ECOG 2 diagnosed with BMs who are not candidates for surgery or SRT, WBRT should be questioned due to short survival.

Introduction: Radiotherapy (RT) is a frequently offered treatment option for brain metastases (BMs) in patients with non-small-cell lung cancer (NSCLC). This study presents patient-reported outcomes (PROs) in a cohort of NSCLC with BMs treated with RT. This study researched how PRO scores at the start of RT may be useful in survival estimates and how PROs change over time after RT. Methods: NSCLC patients with first-time BMs treated with RT were identified in a prospective observational study. PROs were collected at the start of RT and monthly for up to 1 year. Differences in PRO mean scores at the start of RT (M0) and at month 2 (M2) after treatment are reported. Prognostic values of PROs were analyzed in a stepwise adjusted Cox model. Results: Of 294 patients identified, 239 (81%) responded at M0; 105/239 (44%) responded at both M0 and M2. High scores for weakness of legs at M0 were associated with short survival when adjusting for performance status and status of extracranial metastases. Those responding at M0 only had worse mean scores for overall QoL and PF but similar scores for fatigue and dyspnea compared to patients responding over time. At M2, patients with <6 months survival after RT reported worse scores for overall QoL, PF, fatigue, and dyspnea; long-term survivors reported stable scores. Conclusions: NSCLC patients diagnosed with BMs and expected survival < 6 months should be offered optimal palliative care rather than RT.

Few studies have examined cognitive function in long-term survivors with brain metastases (BM). The aim of this study was to assess performance-based cognitive function and compare it with normative samples. Patients with ≥2-year survival after a first-time BM diagnosis completed neuropsychological tests assessing the following neurocognitive domains: processing speed, executive functioning, mental flexibility, visual learning and memory, verbal learning and memory, attention, and working memory. Test scores were converted into standardized z-scores using normative sample means and standard deviations (SD). The proportions of patients with an individual z-score of ≤−1 and ≤−1.5 SD below the normative sample means were calculated to indicate subclinical and clinically significant impairment. Forty-one patients (median age 58, 24 women) completed assessments at a median of 32 months (min–max: 26–47) after the BM diagnosis. On a group level, patients performed poorer than normative samples in tests within all domains except verbal learning and memory. The deviation was most pronounced in a subtest assessing mental flexibility. The proportion of patients with subclinical or clinically significant impairment ranged from 29% to 59% and 7% to 51% between domains, respectively. Seventy-three percent had at least subclinical and 59% had clinically significant impairment in at least 1 domain. Long-term survivors with BM performed poorer than normative samples within nearly all neurocognitive domains, particularly executive functioning and mental flexibility. This domain is important for daily living and social functioning, and clinicians should provide information about the implications of BM and tailor patient care to optimize functioning and quality of life.