Predictive Factors for Local Control and Survival in Patients with Cancer of Unknown Primary (CUP) Irradiated for Cerebral Metastases

Background/Aim: To identify predictors of local control and survival after whole-brain irradiation (WBI) for cerebral metastases from cancer of unknown primary (CUP). Patients and Methods: In 140 patients receiving WBI alone or following resection, seven factors were investigated including treatment approach, WBI-regimen, age, gender, Eastern Cooperative Oncology Group (ECOG) performance score, number of cerebral lesions and extra-cerebral metastases. Results: On univariate analysis, resection plus WBI and boost (p= 0.002), ECOG 0-1 (p< 0.001) and a single lesion (p< 0.001) were positively associated with local control. On Cox regression, ECOG-score remained significant (p= 0.002). On univariate analysis of survival, surgery plus WBI and boost (p= 0.009), ECOG 0-1 (p< 0.001), a single lesion (p= 0.024) and no extra-cerebral metastases (p< 0.001) were associated with better outcomes. On Cox regression, ECOG-score (p< 0.001) and extra-cerebral lesions (p< 0.001) were significant. Conclusion: Significant predictors of local control and survival were identified that contribute to treatment personalization and design of prospective trials in patients with cerebral metastases from CUP.