Whole brain radiotherapy for brain metastases in Nigeria: a systematic review

Abstract

Background Whole brain radiotherapy (WBRT) remains the most commonly used treatment for brain metastases in Nigeria due to limited access to advanced radiotherapy techniques. However, evidence on its outcomes within the Nigerian context has not been systematically summarized. Methods A PRISMA-guided systematic review was conducted to identify studies reporting the use of WBRT for brain metastases in Nigeria by systematic searching of PubMed/Medline, Google Scholar, Embase, and Ajol. Data were extracted on study characteristics, primary tumor profiles, treatment protocols, clinical outcomes, Karnofsky and WHO performance status, and toxicities. Results: Four studies were included in this review, involving a total of 142 patients, with 128 females accounting for 90.1% of the sample size. The mean age was 47.3 ± 12.4 years. CT scan accounts for 70.6% of investigation modalities, MRI (23.5%), Both (5.9%). Mean KPS is 50, breast Cancer accounts for 82.4% of the source of metastases, 66.7% of primary tumors are in stage 3. Multiple metastatic lesions are seen in 85.9% of cases, while 76.9% of cases are supratentorial. Steroid (35%), surgery (9%), and chemotherapy (3%) are additional therapies received. Median survival period ranges between 3 to 18 months with a pooled median survival period of 3.6 months (95% CI: 2.8, 4.4), complete clinical response is seen in 53.8% of patients, with whole brain radiotherapy and improvements in WHO performance status following therapy. Conclusion WBRT continues to provide symptomatic benefit for patients with brain metastases in Nigeria, but is limited by modest survival outcomes and gaps in outcome reporting. Improved access to advanced radiotherapy techniques and standardized reporting are needed to optimize care.