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

J Jung; J Tailor; E Dalton; LJ Glancz; J Roach; R Zakaria; S Lammy; A Chari; KP Budohoski; LJ Livermore; K Yu; MD Jenkinson; PM Brennan; L Brazil; C Bunce; E Bourmpaki; K Ashkan; F Vergani; S Achawa; R Al-Mahfoudh; E Albanese; M Amoo; R Ashida; K Benton; H Bhatt; I Coulter; P D’Urso; A Dapaah; K Dawson; G Dobson; J Duddy; EW Dyson; E Edlmann; L Glancz; P Goetz; A Grivas; P Grundy; C Hannan; L Harrison; S Hassan; D Holliman; A Jamjoom; M Javadpour; J Laban; C Lim; D MacArthur; H McCoubrey; E McKintosh; M Neilly; J Norris; A Nunn; G O’Reilly; K Petridis; P Plaha; J Pollock; C Rajaraman; Rasul F Tariq; W Sage; R Sinha; N Slator; A Smedley; L Thorne; S Trifoi; M Uberti; Ugas M Ali; R Vemaraju; J Walkden; M Waqar; S Yordanov

doi:10.1093/nop/npz063

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

J Jung, J Tailor, E Dalton, LJ Glancz, J Roach, R Zakaria, S Lammy, A Chari, KP Budohoski, LJ Livermore, K Yu, MD Jenkinson, PM Brennan, L Brazil, C Bunce, E Bourmpaki, K Ashkan, F Vergani, S Achawa, R Al-MahfoudhE Albanese, M Amoo, R Ashida, K Benton, H Bhatt, I Coulter, P D’Urso, A Dapaah, K Dawson, G Dobson, J Duddy, EW Dyson, E Edlmann, L Glancz, P Goetz, A Grivas, P Grundy, C Hannan, L Harrison, S Hassan, D Holliman, A Jamjoom, M Javadpour, J Laban, C Lim, D MacArthur, H McCoubrey, E McKintosh, M Neilly, J Norris, A Nunn, G O’Reilly, K Petridis, P Plaha, J Pollock, C Rajaraman, Rasul F Tariq, W Sage, R Sinha, N Slator, A Smedley, L Thorne, S Trifoi, M Uberti, Ugas M Ali, R Vemaraju, J Walkden, M Waqar, S Yordanov

Peninsula Medical School

Research output: Contribution to journal › Article › peer-review

Abstract

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.

Original language	English
Pages (from-to)	344-355
Number of pages	0
Journal	Neuro-Oncology Practice
Volume	7
Issue number	3
Early online date	6 Dec 2019
DOIs	https://doi.org/10.1093/nop/npz063
Publication status	Published - 5 Jun 2020

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10.1093/nop/npz063

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MEMBRAIN
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Jung, J., Tailor, J., Dalton, E., Glancz, LJ., Roach, J., Zakaria, R., Lammy, S., Chari, A., Budohoski, KP., Livermore, LJ., Yu, K., Jenkinson, MD., Brennan, PM., Brazil, L., Bunce, C., Bourmpaki, E., Ashkan, K., Vergani, F., Achawa, S., ... Yordanov, S. (2020). Management evaluation of metastasis in the brain (MEMBRAIN)—a United Kingdom and Ireland prospective, multicenter observational study. Neuro-Oncology Practice, 7(3), 344-355. https://doi.org/10.1093/nop/npz063

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

abstract = "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. ",

author = "J Jung and J Tailor and E Dalton and LJ Glancz and J Roach and R Zakaria and S Lammy and A Chari and KP Budohoski and LJ Livermore and K Yu and MD Jenkinson and PM Brennan and L Brazil and C Bunce and E Bourmpaki and K Ashkan and F Vergani and S Achawa and R Al-Mahfoudh and E Albanese and M Amoo and R Ashida and K Benton and H Bhatt and I Coulter and P D{\textquoteright}Urso and A Dapaah and K Dawson and G Dobson and J Duddy and EW Dyson and E Edlmann and L Glancz and P Goetz and A Grivas and P Grundy and C Hannan and L Harrison and S Hassan and D Holliman and A Jamjoom and M Javadpour and J Laban and C Lim and D MacArthur and H McCoubrey and E McKintosh and M Neilly and J Norris and A Nunn and G O{\textquoteright}Reilly and K Petridis and P Plaha and J Pollock and C Rajaraman and Tariq, {Rasul F} and W Sage and R Sinha and N Slator and A Smedley and L Thorne and S Trifoi and M Uberti and Ali, {Ugas M} and R Vemaraju and J Walkden and M Waqar and S Yordanov",

year = "2020",

month = jun,

day = "5",

doi = "10.1093/nop/npz063",

language = "English",

volume = "7",

pages = "344--355",

journal = "Neuro-Oncology Practice",

issn = "2054-2577",

publisher = "Oxford University Press",

number = "3",

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Jung, J, Tailor, J, Dalton, E, Glancz, LJ, Roach, J, Zakaria, R, Lammy, S, Chari, A, Budohoski, KP, Livermore, LJ, Yu, K, Jenkinson, MD, Brennan, PM, Brazil, L, Bunce, C, Bourmpaki, E, Ashkan, K, Vergani, F, Achawa, S, Al-Mahfoudh, R, Albanese, E, Amoo, M, Ashida, R, Benton, K, Bhatt, H, Coulter, I, D’Urso, P, Dapaah, A, Dawson, K, Dobson, G, Duddy, J, Dyson, EW, Edlmann, E, Glancz, L, Goetz, P, Grivas, A, Grundy, P, Hannan, C, Harrison, L, Hassan, S, Holliman, D, Jamjoom, A, Javadpour, M, Laban, J, Lim, C, MacArthur, D, McCoubrey, H, McKintosh, E, Neilly, M, Norris, J, Nunn, A, O’Reilly, G, Petridis, K, Plaha, P, Pollock, J, Rajaraman, C, Tariq, RF, Sage, W, Sinha, R, Slator, N, Smedley, A, Thorne, L, Trifoi, S, Uberti, M, Ali, UM, Vemaraju, R, Walkden, J, Waqar, M & Yordanov, S 2020, 'Management evaluation of metastasis in the brain (MEMBRAIN)—a United Kingdom and Ireland prospective, multicenter observational study', Neuro-Oncology Practice, vol. 7, no. 3, pp. 344-355. https://doi.org/10.1093/nop/npz063

TY - JOUR

T1 - Management evaluation of metastasis in the brain (MEMBRAIN)—a United Kingdom and Ireland prospective, multicenter observational study

AU - Jung, J

AU - Tailor, J

AU - Dalton, E

AU - Glancz, LJ

AU - Roach, J

AU - Zakaria, R

AU - Lammy, S

AU - Chari, A

AU - Budohoski, KP

AU - Livermore, LJ

AU - Yu, K

AU - Jenkinson, MD

AU - Brennan, PM

AU - Brazil, L

AU - Bunce, C

AU - Bourmpaki, E

AU - Ashkan, K

AU - Vergani, F

AU - Achawa, S

AU - Al-Mahfoudh, R

AU - Albanese, E

AU - Amoo, M

AU - Ashida, R

AU - Benton, K

AU - Bhatt, H

AU - Coulter, I

AU - D’Urso, P

AU - Dapaah, A

AU - Dawson, K

AU - Dobson, G

AU - Duddy, J

AU - Dyson, EW

AU - Edlmann, E

AU - Glancz, L

AU - Goetz, P

AU - Grivas, A

AU - Grundy, P

AU - Hannan, C

AU - Harrison, L

AU - Hassan, S

AU - Holliman, D

AU - Jamjoom, A

AU - Javadpour, M

AU - Laban, J

AU - Lim, C

AU - MacArthur, D

AU - McCoubrey, H

AU - McKintosh, E

AU - Neilly, M

AU - Norris, J

AU - Nunn, A

AU - O’Reilly, G

AU - Petridis, K

AU - Plaha, P

AU - Pollock, J

AU - Rajaraman, C

AU - Tariq, Rasul F

AU - Sage, W

AU - Sinha, R

AU - Slator, N

AU - Smedley, A

AU - Thorne, L

AU - Trifoi, S

AU - Uberti, M

AU - Ali, Ugas M

AU - Vemaraju, R

AU - Walkden, J

AU - Waqar, M

AU - Yordanov, S

PY - 2020/6/5

Y1 - 2020/6/5

N2 - 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.

AB - 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.

U2 - 10.1093/nop/npz063

DO - 10.1093/nop/npz063

M3 - Article

SN - 2054-2577

VL - 7

SP - 344

EP - 355

JO - Neuro-Oncology Practice

JF - Neuro-Oncology Practice

IS - 3

ER -

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

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