Management evaluation of metastasis in the brain (MEMBRAIN)—a United Kingdom and Ireland prospective, multicenter observational study
Authors: Jung Josephine , Tailor Jignesh , Dalton Emma , Glancz Laurence J , Roach Joy , Zakaria Rasheed , Lammy Simon , Chari Aswin , Budohoski Karol P , Livermore Laurent J , Yu Kenny , Jenkinson Michael D , Brennan Paul M , Brazil Lucy , Bunce Catey , Bourmpaki Elli , Ashkan Keyoumars , Vergani Francesco ,   British National Trainee Research Collaborative (BNTRC), Achawa Shailendra , Al-Mahfoudh Rafid , Albanese Erminia , Amoo Michael , Ashida Reiko , Benton Kirsty , Bhatt Harsh , Coulter Ian , D’Urso Pietro , Dapaah Andrew , Dawson Kelly , Dobson Gareth , Duddy John , Dyson Edward W , Edlmann Ellie , Glancz Laurence , Goetz Pablo , Grivas Athanasios , Grundy Paul , Hannan Cathal , Harrison Lianne , Hassan Syed , Holliman Damian , Jamjoom Aimun , Javadpour Mohsen , Laban James , Lim Chris , MacArthur Donald , McCoubrey Helen , McKintosh Edward , Neilly Mark , Norris John , Nunn Adam , O’Reilly Gerry , Petridis Konstantinos , Plaha Puneet , Pollock Jonathan , Rajaraman Chittoor , Tariq Rasul Fahid , Sage William , Sinha Rohit , Slator Naomi , Smedley Alexander , Thorne Lewis , Trifoi Sebastian , Uberti Micaela , Ali Ugas Mohamed , Vemaraju Ravi , Walkden James , Waqar Mueez , Yordanov Stefan 
Published: December 2019

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 &lt; .001) as well as sentinel location and tumor histology (P &lt; .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.