Combined Razoxane and Radiotherapy for Melanoma Brain Metastases. A Retrospective Analysis

Abstract

We retrospectively compared the efficacy of razoxane and radiotherapy with radiotherapy alone or in combination with a non-razoxane based medication in patients with melanoma brain metastases. From 19 assessable patients receiving whole brain irradiation with or without a boost (mean total dose 40.5 Gy) for measurable brain metastases, 8 patients underwent an additional razoxane therapy with 125 mg per os twice daily started 5 days before radiotherapy and given throughout the whole radiation period. The median razoxane dose was 6.25 g (range 3.2-8.0 g). Endpoints included radiation response rates, median survival time and 1-year survival rates. To generate reliable prognostic parameters for this non-randomized study population, the Score Index for Stereotactic Radiosurgery and the Radiation Therapy Oncology Group Recursive Partitioning Analysis score were applied. Radiotherapy with razoxane led to higher response rates (62% vs. 27%) and a lower percentage of progressive disease (12.5% vs. 36%) if compared with radiotherapy alone or with a non-razoxane based medication. This combination was associated with a longer median survival (5 months vs. 2.2 months; P=0.052) and a 1-year survival rate of 37.5% vs. 0% (P=0.027). Both treatment groups belonged to similar prognosis subsets. The treatment was well tolerated. Taken together our data support the therapeutic concept of a combined razoxane radiation therapy in melanoma patients with brain metastases. The favorable treatment effects are probably due to the radiosensitizing and the cytorallentaric mode of action of razoxane. Since the patient numbers are low, confirmatory studies are certainly necessary.

Quality of Life in Brain Metastases Radiation Trials: A Literature Review

“…Two retrospective trials examined the outcomes of multiple treatments including WBRT, surgery, chemotherapy, or supportive care 42,43 . Twelve studies examined the use of various WBRT dose fractionation schedules 6,10,22,28,[44][45][46][47][48][49][50][51] , and seven trials assessed the efficacy of radiosensitizers and WBRT as compared with WBRT alone 9,21,24,25,[52][53][54] . Chemotherapy and WBRT were compared in eight studies 7,8,[55][56][57][58][59][60] .…”

“…A preponderance of the published trials used a performance status scale such as the Karnofsky performance status (KPS) to quantify the general well-being of patients with brain metastases 19,[22][23][24][25] . The purpose of a performance status assessment is to quantify a patient's level of function, level of ambulation, and ability for self-care 26 .…”

Treating Recurrent Cases of Squamous Cell Carcinoma with Radiotherapy

“…Two retrospective trials examined the outcomes of multiple treatments including wbrt , surgery, chemotherapy, or supportive care 42,43. Twelve studies examined the use of various wbrt dose fractionation schedules 6,10,22,28,44–51, and seven trials assessed the efficacy of radiosensitizers and wbrt as compared with wbrt alone 9,21,24,25,52–54. Chemotherapy and wbrt were compared in eight studies 7,8,55–60.…”

“…A preponderance of the published trials used a performance status scale such as the Karnofsky performance status ( kps ) to quantify the general well-being of patients with brain metastases 19,22–25. The purpose of a performance status assessment is to quantify a patient’s level of function, level of ambulation, and ability for self-care26 The kps is rated in increments of 10 on a scale of 0 to 100, with 100 meaning “normal, no complaints, no signs of disease” and 0 meaning “death”.…”

Functional Assessment of Cancer Therapy-Brain questionnaire: translation and linguistic adaptation to Brazilian Portuguese

“…Thus far, the majority of studies have used the Karnofsky scale to assess general wellbeing and the Barthel index to assess functional capacity, 23,24 but these scales are not capable of assessing the quality of life of patients with a diagnosed brain tumor.…”