Cerebral metastases: value of reirradiation in selected patients

Fifty-two adult patients were selected to receive a second course of cranial radiation therapy to relieve symptoms caused by recurrent cerebral metastases. To be selected, patients had to (a) have remained in relatively good general condition for at least 4 months after their initial course of radiation therapy and (b) experience renewed deterioration of their neurologic condition. Initial treatment typically consisted of 3,000 cGy administered in 10 fractions over 2 weeks to the whole brain. Reirradiation most commonly consisted of 2,500 cGy in 10 fractions. Twenty-two patients (42%) responded to reirradiation and improved by at least one level in their neurologic function status. Survival after second therapy averaged 5 months. The authors conclude that reirradiation of cerebral metastases should be considered for patients who remain in good general condition but who experience neurologic deterioration 4 or more months after satisfactory response to initial palliative cerebral radiation therapy.