Reduction of Overall Treatment Time in Patients Irradiated for More Than Three Brain Metastases

Dirk Rades, Susanne Kieckebusch, Radka Lohynska, Theo Veninga, Lukas J.A. Stalpers, Juergen Dunst, Steven E. Schild

Research output: Contribution to journalArticlepeer-review

49 Scopus citations

Abstract

Purpose: Patients with multiple brain metastases usually receive whole brain radiotherapy (WBRT). A dose of 30 Gy in 10 fractions (10 × 3 Gy) in 2 weeks is the standard treatment in many centers. Regarding the poor survival of these patients, a shorter RT regimen would be preferable if it provides a similar outcome as that with 10 × 3 Gy. This study compared 20 Gy in five fractions (5 × 4 Gy) within 5 days to 10 × 3 Gy. Methods and Materials: Data from 442 patients treated with WBRT for multiple brain metastases were retrospectively analyzed. Survival and local control within the brain of 232 patients treated with 5 × 4 Gy were compared with the survival and local control within the brain of 210 patients treated with 10 × 3 Gy. Seven additional potential prognostic factors were investigated: age, gender, Karnofsky performance score, tumor type, interval from tumor diagnosis to RT, extracranial metastases, and recursive partitioning analysis class. Results: On univariate analysis, the WBRT program was not associated with survival (p = 0.29) or local control (p = 0.07). On multivariate analyses, improved survival was associated with a lower recursive partitioning analysis class (p < 0.001), age ≤60 years (p = 0.001), Karnofsky performance score ≥70 (p = 0.015), and the absence of extracranial metastases (p = 0.005). Improved local control was associated with a lower recursive partitioning analysis class (p < 0.001), Karnofsky performance score ≥70 (p < 0.001), and breast cancer (p = 0.043). Grade 3 acute toxicity rates were not significantly different between 5 × 4 Gy and 10 × 3 Gy. Conclusions: Shorter course WBRT with 5 × 4 Gy was associated with similar survival and local control as "standard" WBRT with 10 × 3 Gy in patients with more than three brain metastases. The 5 × 4-Gy regimen appears preferable for most of these patients, because it is less time consuming and more convenient for patients than the 10 × 3-Gy regimen.

Original languageEnglish (US)
Pages (from-to)1509-1513
Number of pages5
JournalInternational Journal of Radiation Oncology Biology Physics
Volume69
Issue number5
DOIs
StatePublished - Dec 1 2007

Keywords

  • Multiple brain metastases
  • Overall treatment time
  • Shorter course radiotherapy
  • Survival

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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