Dose escalation beyond 30 grays in 10 fractions for patients with multiple brain metastases

Abstract

BACKGROUND. Whole‐brain radiotherapy (WBRT) to 30 grays (Gy) in 10 fractions is the standard treatment in patients with multiple brain metastases in the majority of treatment centers worldwide. The current study investigated the potential benefit of dose escalation beyond 30 Gy. METHODS. Data regarding 416 patients who were treated with WBRT for multiple brain metastases were evaluated retrospectively. Survival and freedom from recurrent brain metastasis (local control) of 257 patients who were treated with 10 fractions of 3 Gy each for 2 weeks were compared with those of 159 patients treated with 45 Gy in 15 fractions for 3 weeks or 40 Gy in 20 fractions for 4 weeks. Eight additional potential prognostic factors were investigated including age, gender, Karnofsky performance score (KPS), tumor type, interval between tumor diagnosis and RT, number of metastases, extracranial metastases, and Recursive Partitioning Analysis (RPA) class. RESULTS. On multivariate analysis, improved survival was found to be associated with lower RPA class (P < .001), age <60 years (P = .026), KPS ≥70 (P < .001), and absence of extracranial metastases (P = .003). A trend was observed for number of metastases (2–3 vs ≥4; P = .07). Improved local control was associated with a KPS ≥70 (P < .001) and breast cancer (P < .001). A trend was observed for number of metastases (P = .059). The RT schedule did not appear to have any significant impact on survival (P = .86) or local control (P = .61). The subgroup analyses, performed for each of the 3 RPA classes, did not demonstrate a significantly better outcome with dose escalation. CONCLUSIONS. Dose escalation beyond 30 Gy in 10 fractions does not appear to improve survival or local control in patients with multiple brain metastases but does increase the treatment time and cost of therapy. Cancer 2007. © 2007 American Cancer Society.

Resource Utilization in Patients with Brain Metastases Managed with Best Supportive Care, Radiotherapy and/or Surgical Resection: A Markov Analysis

“…Treatment was highly individualized, taking primary diagnosis, previous therapies and established prognostic factors into consideration [2]. Survival for the different management strategies was within the range of previously reported results [8,9]. This is also true for patients who received systemic chemotherapy (7 months as in the retrospective non-small cell lung cancer study by Kim et al [6] and the subgroup analysis of a prospective phase III trial by Edelman et al [10] in the same cancer type).…”

Radiotherapy of brain metastases from breast cancer: Treatment results and prognostic factors

“…This topic is controversial in the literature. Certain authors evaluated various radiation schemes and were unable to detect improved survival if patients were treated with a total dose >30 Gy (27)(28)(29). By contrast, two retrospective studies by Mahmoud-Ahmed et al (30) and Meyer et al (31) observed a survival benefit in patients who were treated with a WBRT dose of >30 Gy.…”

Técnica field in field em planejamentos bidimensionais para irradiação de cérebro total

“…Dos diversos esquemas de fracionamento, 30 Gy liberados em 10 frações é o protocolo usual [13]. Doses acima de 30 Gy não aumentam a sobrevida ou controle local de pacientes com múltiplas metástases e frações diárias superiores a 3 Gy podem aumentar o risco de toxicidade [14]. Profilaticamente, a irradiação de cérebro total é utilizada para diminuir a incidência de metástases em indivíduos precocemente diagnosticados com câncer de pulmão de pequenas células ou leucemia linfoblástica aguda.…”