Cancer patients who develop cerebral metastases deserve any benefits radiation therapy treatments can provide without further degrading the quality of life during their remaining months of survival. When estimated survival is measured in months rather than years, incremental improvements in treatment are noteworthy.
Researchers from St. George Hospital's Cancer Care Centre in Kogarah, Australia, reporting on a randomized clinical trial of 113 patients, found marginally better outcomes of intracranial disease control when a 40-Gy dose of whole-brain radiotherapy was administered in 20 twice-daily fractions as compared to a 20-Gy dose in four daily fractions. Their findings were published in the July 1 issue of the International Journal of Radiation Oncology, Biology, Physics (2010, Vol. 77:3, pp. 648-654).
In the study, 113 patients were enrolled over a 10-year period starting February 1996. They were followed for up to five years or to the time of their death. The patients were randomized to receive either 40 Gy in twice-daily fractions or 20 Gy in four daily fractions, all treatments given on weekdays. In the 40-Gy group, 52 of the 57 patients completed the treatment; only one patient did not complete the 20-Gy treatment.
The median interval to central nervous system progression was 9.2 months for the patients in the 40-Gy dose group and 5.1 months in the 20-Gy group. Death was attributed to central nervous system progression for 32% of the patients in the 40-Gy dose group and 52% for the 20-Gy dose group. However, median survival of six months after treatment was the same for both groups.
Lead author Peter Graham and colleagues reported that quality of life was not impaired in the first three months following treatment for the patients who received the larger radiotherapy dose, and that the requirements for steroid use was less prolonged.
The authors suggest that treatment with more intense whole-brain radiotherapy might be beneficial for patients who are unsuitable for stereotactic radiotherapy or for whom this treatment option is not available.
Related Reading
New guidelines issued for treatment of brain metastases, January 20, 2010
Prophylactic RT decreases risk of brain metastases, November 3, 2009
Whole brain radiation for mets may be ineffective, September 24, 2009
Cranial irradiation decreases brain metastases, June 2, 2009
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