Randomized Comparison of Whole Brain Radiotherapy, 20 Gy in Four Daily Fractions Versus 40 Gy in 20 Twice-Daily Fractions, for Brain Metastases

Graham, PH; Bucci, Joseph; Browne, Lois

doi:10.1016/j.ijrobp.2009.05.032

Cited by 67 publications

(40 citation statements)

References 19 publications

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“…As far as small cell lung cancer is concerned, radiosurgery appears to provide excellent local control but patients remain at significant risk from subsequent distant failure elsewhere in the brain [18], and often in the context of relapsed extracranial disease [19]. Alternative schedules of whole brain irradiation may provide superior local control than previously reported in patients unsuitable for radiosurgery [20]. One of the principal limitations of the PCI studies is the absence of or limited radiological surveillance reported in the no PCI arms.…”

Section: Discussionmentioning

confidence: 99%

Prophylactic cranial irradiation (PCI). Still a no-brainer?

2015

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Although prophylactic cranial irradiation (PCI) has been the standard of practice for patients successfully treated for limited stage small cell lung cancer for decades, subsequent changes in patient selection, updated brain imaging guidelines, an increased understanding of the mechanisms underlying the deleterious effects of whole brain irradiation as well as ongoing investigations into improving radiation treatment delivery have begun to question the current role of PCI. Who should be treated and how? This review attempts to gather together evidence for improving patient selection and describe potential improvements in treatment delivery.

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Section: Discussionmentioning

confidence: 99%

Prophylactic cranial irradiation (PCI). Still a no-brainer?

2015

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“…As discussed by different authors [11][12][13][14], WBRT with 5 fractions of 4 Gy (BED 28 Gy10) results in comparable local control and survival to more prolonged regimens (103 Gy (BED 39 Gy10), 153 Gy (BED 58.5 Gy10), 202 Gy (BED 48 Gy10)). The 54 Gy regimen is less time consuming and more convenient for patients than prolonged fractionation, which should only be considered for better prognosis subgroups and patients receiving WBRT after surgical resection [15,16]. Even more hypofractionated regimens such as 18 Gy in 3 fractions (BED 28.8 Gy10) have been studied but these WBRT regimens have not been widely adopted, most likely because of concerns about toxicity [17].…”

Section: Discussionmentioning

confidence: 99%

Does overall treatment time impact on survival after whole-brain radiotherapy for brain metastases?

et al. 2011

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PURPOSE To evaluate whether reduced overall treatment time (OTT), i.e., administration of more than 5 fractions per week, or uncompensated treatment interruption resulting in increased OTT influences survival of patients treated with whole-brain radiotherapy (WBRT) for brain metastases. METHODS Retrospective multi-institutional intention-to-treat study including 233 patients treated with primary WBRT (prescribed dose 10 fractions of 3 Gy; no previous SRS or surgery) administered over 10-38 days. Four groups were studied: OTT 10-11 vs. 12 days, 13-15 or >15 days. RESULTS Fourteen patients (6%) failed to complete WBRT and received 3-9 fractions (median 7). Their median survival was 0.5 months as compared to 3 months in patients who completed WBRT. No significant impact of OTT on survival was found. Median survival was 1.5, 2.9, 3.0 and 3.1 months in the four groups mentioned above. CONCLUSIONS Compensation for unintended treatment interruption is generally recommended but might not always be feasible. Depending on histological tumour type or expected repopulation, prognostic factors and neurological status, it might be acceptable to complete an interrupted course of WBRT without compensation in selected patients. While survival might be largely independent from OTT, it should also be evaluated whether this parameter has any impact on quality of life and duration of palliation.

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“…A randomized study of 40 Gy in 20 twice-daily fractions compared with 20 Gy in 4 daily fractions showed that patients treated with the higher dose twice-daily treatment had better intracranial tumor control (intracranial progression in 44 % with 40 Gy in 20 twice-daily fractions vs. 64 % with 20 Gy in 4 daily fractions, p00.03) with similar quality of life measures using the European Organization for Research and Treatment of Cancer Quality of Life 30-item questionnaire. This improvement in intracranial tumor control did not result in significant improvement in overall survival with median survival of 6.1 vs. 6.6 months for 40 Gy in 20 twice-daily fractions vs. 20 Gy in 4 daily fractions, respectively [6]. Numerous prospective trials have failed to reveal any effect upon survival between alternative fractionation schemes ( Table 1).…”

Section: Whole Brain Radiotherapymentioning

confidence: 93%

Conventional radiation therapy for brain metastases

2012

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Conventional radiotherapy in the form of whole brain radiation treatment has been a longstanding treatment for brain metastases, and it continues to provide effective palliation as monotherapy and in combination with local and systemic treatments. Advances in systemic therapy have improved survival with metastatic disease, and in those patients with better prognostic factors, more aggressive local therapeutic approaches for brain metastases appear to benefit their survival and intracranial tumor control. Increased treatment intensity and longer survival following treatment of brain metastases have raised concerns about persistent treatmentrelated neurocognitive toxicities and the resulting impact on quality of life. Technological advances in conventional radiotherapy planning and delivery have led to novel approaches that may increase intracranial tumor control while minimizing the treatment-related toxicities of therapy. These innovative approaches include intensitymodulated radiotherapy, new image-guidance techniques, and volumetric modulated arc therapy, which allow for the delivery of whole brain radiotherapy with integrated boost treatment to the visible disease while sparing the hippocampal regions or delivery of hypofractionated radiotherapy to larger metastatic targets that may not be amenable to radiosurgery boost or salvage treatment.

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Randomized Comparison of Whole Brain Radiotherapy, 20 Gy in Four Daily Fractions Versus 40 Gy in 20 Twice-Daily Fractions, for Brain Metastases

Cited by 67 publications

References 19 publications

Prophylactic cranial irradiation (PCI). Still a no-brainer?

Prophylactic cranial irradiation (PCI). Still a no-brainer?

Does overall treatment time impact on survival after whole-brain radiotherapy for brain metastases?

Conventional radiation therapy for brain metastases

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