SURVIVAL AND PROGNOSTIC FACTOR ANALYSIS IN WHOLE BRAIN IRRADIATION OF PATIENTS WITH BRAIN METASTASES

Objective: The aim of the study was to analyse the survival results in patients with brain métastasés treated by whole brain external radiotherapy and determine the prognostic factors affecting survival.Methods: Eighty-three patients with brain métastasés were treated by external radiotherapy. Before irradiation 21 had metastatectomy, 4 had stereotactic radiosurgery and 4 had stereotactic biopsy for diagnosis. The primary tumor was controlled in 39 patients (47%), 30 (36%) had métastasés other than brain. Whole cranial irradiation was performed on all patients by a linear accelerator with 6 MV energy.Results: Median follow-up for all patients was 14 weeks (1-143 weeks). Median overall survival and 1 year survival for the whole group was 14 weeks and 25%, respectively. Cranial progression free survival was median 40 weeks. In multivariate analysis Karnofsky Performance Scale score, gender and metastatectomy / radiosurgery were found to be independent prognostic factors.Conclusion: External radiotherapy is an efficient treatment modality for palliation and stabilizing cranial progression in patients with brain métastasés. Better survival results are obtainedin younger, solitary metastatic patients with good performance status and controlled systemic disease when metastatectomy or radiosurgery added.Key Words: Brain métastasés, Radiotherapy, Prognostic factors.

___

  • Patchett HA, Tibbs PA, Walsh JW, et al. A randomized trial of surgery in the treatment of single métastasés to the brain, hi Engl J Med 1990; 322: 494-499.
  • Cola LH. The role of radiation therapy in the treatment of brain métastasés. Int J Hadiat Oncol Biol Phys 1992; 23: 229-238.
  • Arbit E, Wronski M. The treatment of brain métastasés, hieurosurg Q 1995; 5: 1.
  • Delattre JY, Krol G, Thaler HT, et al. Distribution of brain métastasés. Arch hieurol 1988; 45: 741-744.
  • Posner JB. neurologic complications of cancer. Philadelphia: PA Davis, 1995: 37.
  • Borgelt B, Gelber R, Kramer S, et al. The palliation of brain métastasés: Pinal results of the first two studies of the Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys 1980; 6: 1-19.
  • Wright DC, Delaney TP, Buchner JC. The treatment of metastatic cancer to the brain. In DeVita VT, Heilman S, Rosenberg 5/1, eds. Cancer: Principles and practice of oncology, 4th ed. Philadelphia: JB Lippincott, 1993: 21 70-2185.
  • Auchter RM, Lamond JP, Alexander EA, et al. A multi-institutional outcome and prognostic factor analysis of radiosurgery for resectable single brain metastasis. Int J Radiat Oncol Biol Phys 1996; 35: 27-36.
  • Kaplan E, Meier P. hion-parametric estimations from incomplete observations. J Am Stat Assoc 1958; 453: 457-480.
  • Cox DR. Regression models and life tables (with discussion). J Stat Soc (B) 1972; 34: 187-220.
  • Kurtz J, Gelber R, Brady L, et ah The palliation of brain métastasés in a favorable patient population. A randomized clinical trial by the Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys 1981; 7: 891-895.
  • Komarnicky LT, Phillips TL, Martz K, et al. A randomized phase III protocol for the evaluation of misonidazole combined with radiation in the treatment of patients with brain métastasés (RTOG-7916). Int J Radiat Oncol Biol Phys 1991; 20: 53-58.
  • Diener-West M, Dobbins T, Phillips T, Kelson D. Identification of an optimal subgroup for treatment evaluation of patients with brain métastasés using RTOG study 7916. Int J Radiat Oncol Biol Phys 1989; 16: 669-673.
  • Hoordijk EM, Vecht CJ, Haaxma-Reiche H, et al. The choice of treatment of single brain métastasés should be based on extracranial tumor activity and age. Int J Radiat Oncol Biol Phys 1994; 29: 711-717.
  • Chang SD, Lee E, Sakamoto GT, Brown HP, Adler JR. Stereotactic radiosurgery in patients with multiple brain métastasés, hieurosurg Focus 2000; 9(2)-.Article 3:1 -5.
  • Cho KH, Hall lVA, Gerbi BJ, Higgins PD. The role of radiosurgery for multiple brain métastasés, hieurosurg Focus 2000; 9(2): Article 2:1-7.