Management evaluation of metastasis in the brain (MEMBRAIN)—a United Kingdom and Ireland prospective, multicenter observational study

Abstract

Background In recent years an increasing number of patients with cerebral metastasis (CM) have been referred to the neuro-oncology multidisciplinary team (NMDT). Our aim was to obtain a national picture of CM referrals to assess referral volume and quality and factors affecting NMDT decision making. Methods A prospective multicenter cohort study including all adult patients referred to NMDT with 1 or more CM was conducted. Data were collected in neurosurgical units from November 2017 to February 2018. Demographics, primary disease, KPS, imaging, and treatment recommendation were entered into an online database. Results A total of 1048 patients were analyzed from 24 neurosurgical units. Median age was 65 years (range, 21-93 years) with a median number of 3 referrals (range, 1-17 referrals) per NMDT. The most common primary malignancies were lung (36.5%, n = 383), breast (18.4%, n = 193), and melanoma (12.0%, n = 126). A total of 51.6% (n = 541) of the referrals were for a solitary metastasis and resulted in specialist intervention being offered in 67.5% (n = 365) of cases. A total of 38.2% (n = 186) of patients being referred with multiple CMs were offered specialist treatment. NMDT decision making was associated with number of CMs, age, KPS, primary disease status, and extent of extracranial disease (univariate logistic regression, P < .001) as well as sentinel location and tumor histology (P < .05). A delay in reaching an NMDT decision was identified in 18.6% (n = 195) of cases. Conclusions This study demonstrates a changing landscape of metastasis management in the United Kingdom and Ireland, including a trend away from adjuvant whole-brain radiotherapy and specialist intervention being offered to a significant proportion of patients with multiple CMs. Poor quality or incomplete referrals cause delay in NMDT decision making.

Impact of multidisciplinary team on the pattern of care for brain metastasis from breast cancer

“…These complications often contribute to poor prognosis ( 18 – 20 ) and serve as common reasons for MDT referrals ( 21 , 22 ). Another important role of MDTs is to facilitate effective and efficient communication among different specialists ( 23 ), shortening the time required for differential diagnosis and therapeutic decision-making ( 24 , 25 ). In our current research, although only the intracranial lesions at the time of initial BM were recorded, it was found that 53.3% of patients experienced upgrades in their intracranial diagnoses following MDT discussions.…”

The Role of the Immune Response in Brain Metastases: Novel Imaging Biomarkers for Immunotherapy

“…malignant melanoma. This has led to BM occupying substantially more of the neurosurgery, radiology, and oncology workload compared to other brain tumors in recent years (1).…”

“…Incidence increases with age and varies with the primary, being most common in non-small-cell lung cancer, breast cancer, and malignant melanoma. This has led to BM occupying substantially more of the neurosurgery, radiology, and oncology workload compared to other brain tumors in recent years ( 1 ).…”

The Role of Stereotactic Biopsy in Brain Metastases

“…Prognosis and thus decision support for treatment remains partially defined with considerable variation amongst cancer types and molecular features, systemic manifestations, and treatment tolerance 8,10 . Prognostic factors include age, performance status, extra-cranial metastases, treatment history and most importantly the extent of primary disease control 1,9,11,12 .…”