The Use of Palliative Whole Brain Radiotherapy in the Management of Brain Metastases

Aims: To describe the use of palliative whole brain radiotherapy (WBRT) in the management of brain metastases in the general cancer population and to identify factors associated with variations in its use. Materials and methods: We conducted a retrospective population-based study of patients who died of cancer in Ontario from 1984 to 2007 and identified those who received WBRT before death. Univariate and multivariate analyses were carried out to identify factors associated with the use of WBRT. Results: Of the 494 709 patients who died of cancer, 5.7% received WBRT. The rate of use of WBRT varied across the province, with county rates ranging from 1.3 to 8.8%. Younger patients and patients living in communities of higher socioeconomic status were more likely to receive WBRT, as were patients diagnosed in a hospital with a radiotherapy facility or living closer to a radiotherapy centre (P < 0.0001). The rate of use of WBRT was stable over the study period. Conclusion: There are inequities in the use of WBRT for the management of brain metastases that are not associated with need. Strategies to increase patient access to WBRT need to be developed and evaluated to ensure optimal outcomes. (C) 2012 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.