Prognosis of patients treated for intracranial metastases with whole-brain irradiation

Abstract

Seventy-five patients with brain metastases from solid tumours were treated with whole-brain irradiation at our institution between 1990 and 1993. The primary cancers included 35 cases of lung cancer, 19 cases of breast cancer, nine cases of renal-cell cancer, six cases of melanoma and six cases of other primary sites. In each case the total dose to the whole brain was at least 25 gray (Gy). The primary site, age, performance status, number of brain metastases and the presence of extracranial disease were studied as prognostic factors for survival. The median survival for the whole population was 4 months (range 1-62 months). The patients with the brain as the only metastatic site had significantly better survival (P = 0.019) than those with both intracranial and extracranial metastatic sites. Poor performance status at the time of diagnosis of brain metastases was also related to short survival (P = 0.001). None of the other studied variables had prognostic significance. Four of the 75 patients with primary tumour sites in the breast (two patients) and the kidney (two patients) survived for more than 2 years. In general, patients with breast cancer had better survival than patients with other primary cancers. Our study confirms the generally poor prognosis of cancer with brain metastases, although individual patients may survive several years after whole-brain irradiation. Approximately two-thirds of the patients experienced a relief in symptoms allowing a reduction in the dose of corticosteroid medication, which clearly supports the use of whole-brain radiotherapy as a palliative treatment.

Whole brain radiotherapy results of patients with brain metastases and investigation of their prognostic factors

“…[5] Tanı aldıktan sonra tedavi edilmiş hastalarda ortanca sağkalım dört aydır. [6] Çalışmamız-daki hastaların ortanca sağkalım süresi ise 6.9 aydı.…”

Oral temozolomide in heavily pre-treated brain metastases from non-small cell lung cancer: Phase II study

“…Among patients affected by advanced NSCLC up to 40% have BrM identifiable at autopsy [1]. Whole brain radiotherapy (WBRT) improves neurological symptoms in about 50% of patients and lengthens the median survival from 3 to 6 months [2]. Recent trials suggest that epipodophillotoxins alone or combined with cisplatin are very effective in treating NSCLCrelated BrM and ifosfamide-mitomycin-cisplatin or gemcitabine-cisplatin combinations have been evaluated with similar good responses [3][4][5][6][7][8][9].…”

Brain metastases

“…Depending on the patients' general health, radiotherapy may lead to improved survival (up to approximately 4 months) in selected cases. [3][4][5] However, any treatment must be carefully tailored to avoid unnecessary treatment burden and toxicity during the last few weeks of life.…”