OP20. THE IMPLICATIONS OF RISING CEREBRAL METASTASES INCIDENCE ON A LARGE-VOLUME NEURO-ONCOLOGY MULTI-DISCIPLINARY TEAM (MDT)

BACKGROUND: The incidence of cerebral metastases (CM) encountered in clinical practice is increasing due to improved diagnostic imaging, global increase in primary cancer incidence and improved survival. The implications for neuro-oncology multi-disciplinary teams in tertiary referral centres are rarely reported. AIM: To review the current trends in CM referrals to our neuro-oncology MDT, including number of referrals, primary source demographics, MDT decisions and referral quality. METHOD: We conducted a 5-year systematic audit of all CM referrals to a large-volume multidisciplinary neuro-oncology team (MDT) and used the 2006 National Institute of Clinical Excellence (NICE) guidelines to benchmark. RESULTS: A total of 728 CM referrals were made from March 2009 through February 2014 (53.6% female and 46.4% male). We demonstrate a yearly increase in the total number of new CM referrals to the neuro-oncology MDT. The commonest primary sources were lung (31.9%), breast (19.9%), and colorectal cancers (5.4%). Despite increase in total referrals, the number of CM patients accepted by the MDT for specialist intervention (neurosurgery or stereotactic radiosurgery (SRS)) did not increase, whilst the number being advised for local management (palliation or whole brain radiotherapy) increased significantly. An increasing number of patients with multiple cerebral metastases were referred to the MDT over the 5-year period. We also found large proportion of CM referrals were incomplete with regards to inclusion of performance status and estimated prognosis, and a large number of patients had not been investigated for a primary source prior to referral (17.9%). CONCLUSION: The rising trend in CM referrals to neuro-oncology MDT is, to a large extent, driven by the referral of patients outside the original NICE guidelines such as those with multiple metastases.. The quality of referral information also falls short of NICE recommendations. Whilst the concept of MDT management may be applicable to all patients with metastatic brain disease, and complex neurosurgical interventions may be appropriate in a cohort of those with oligo-metastatic disease, the current set up of neuro-oncology MDTs, as directed by NICE guidelines, is not intended or designed to cater for these cases. The restructuring or diversification of neuro-oncology MDTs, supported with appropriate funding, will be required to address growing demands on these services. In the meantime, re-educating referrers on the NICE guidelines regarding the referral of patients with CM may go some way in balancing the current workload of the neuro-oncology MDTs.