Aims. To evaluate whether reduced waiting time influences survival of patients treated with whole-brain radiotherapy (WBRT) for brain metastases. Materials and Methods. Retrospective intention-to-treat study including 110 patients treated with primary WBRT (typically 10 fractions of 3？Gy; no other treatment between diagnosis and WBRT). Uni- and multivariate tests were performed. Results. Median delay between imaging diagnosis and WBRT was 12 days (range 0–66 days). WBRT started within 1 week in 36%, during the second week in 28%, and during the third week in 18% of patients. No significant correlation between waiting time and survival was evident, except for one subgroup of patients. Those without extracranial metastases (potentially more threatened by worse intracranial disease control) survived for a median of 2.5 months from WBRT if waiting time was 2 weeks or longer as compared to 5.6 months if waiting time was shorter than 2 weeks ( ). The same correlation was seen if survival was computed from imaging diagnosis. Conclusion. If departmental resources are not sufficient to provide immediate WBRT within 2 weeks to all patients, those without extracranial metastases should be prioritised. This study did not address the impact of waiting time on quality of life or symptom palliation. 1. Introduction On an international scale, access to palliative radiotherapy varies with geographic region, health care system, and sociodemographic factors [1, 2]. The presence of waiting lists might cause distress, unnecessary symptom burden, and under certain circumstances compromised outcomes, at least if long waiting time is unavoidable. Regarding treatment of brain metastases, a considerable number of patients continue to receive palliative whole-brain radiotherapy (WBRT) [3, 4]. Administration of 10 fractions of 3？Gy over 2 weeks or 5 fractions of 4？Gy over one week is commonly used fractionation regimens in many countries [5]. Given that median survival of patients managed with best supportive care is limited (in the order of 4–6 weeks [6, 7]), one might assume that delays in starting WBRT should be minimised, if such treatment is indicated and the preferred therapeutic option. Clinical data on the impact of variable waiting times between imaging diagnosis of brain metastases and initiation of WBRT on survival after radiotherapy are scarce [8]. Therefore, we evaluated survival of a contemporary cohort of patients treated with WBRT. 2. Patients and Methods We analysed patients from a previously described multi-institutional brain metastases database, which is
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