Palliative radiotherapy of cerebral metastasis from lung cancer

Cerebral metastasis is a common manifestation of lung cancer. Presenting signs and symptoms are often grave, and consequently often result in patients being debilitated for the rest of their lives. Radiotherapy has been used to treat a majority of these cases, and is considered as the treatment of choice. At Mackay Memorial Hospital, we collected from 1982 to 1985, the records of 42 lung cancer patients with brain metastasis. All the cases had a histological diagnosis of primary lung cancer; most of them were squamous cell carcinoma and adenocarcinoma; only two cases were small cell carcinoma. The diagnosis of brain metastasis was established by computed tomographic scans of the brain and radioisotopic brain scans. Of the 42 cases, 22 received palliative radiotherapy from a cobalt-60 teletherapy machine to the whole brain for a total dose of 30 Gray (Gy) in 10-15 fractions over a time span of 2 to 3 weeks, while the remaining patients only received medical treatment (e.g. cranial decompression with mannitol, steroids, etc.). Most of the patients have already died. In our study, those who received radiotherapy attained considerable palliation of their symptoms and signs, including improvement of their general performance status and neurological function. Although the treatment did not prolong the patient's survival, it did decrease considerably the disability caused by the metastatic disease.