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

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

doi:10.1016/j.ijrobp.2007.05.014

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Volume 69, Issue 5 , Pages 1509-1513, 1 December 2007

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

Dirk Rades, M.D.
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Luebeck, Germany
- Department of Radiation Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
- Reprint requests to: Dirk Rades, M.D., Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, Luebeck D-23538 Germany. Tel: (++49) 451-500-6661; Fax: (++49) 451-500-3324
Susanne Kieckebusch, M.D.
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Luebeck, Germany
Radka Lohynska, M.D.
- Department of Radiation Oncology, University Hospital, Prague, Czech Republic
Theo Veninga, M.D.
- Department of Radiotherapy, Dr. Bernard Verbeeten Institute, Tilburg, The Netherlands
Lukas J.A. Stalpers, M.D.
- Department of Radiotherapy, Academic Medical Center, Amsterdam, The Netherlands
Juergen Dunst, M.D.
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Luebeck, Germany
Steven E. Schild, M.D.
- Department of Radiation Oncology, Mayo Clinic Scottsdale, Scottsdale, AZ

Received 5 February 2007; received in revised form 16 April 2007; accepted 5 May 2007. published online 07 August 2007.

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.

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