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Accelerated radiotherapy for brain metastases

C Nieder1, U Nestle, M Niewald

  • 1Department of Radiotherapy, University Hospital, Homburg/Saar, Germany.

Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology
|November 19, 1997
PubMed
Summary
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Accelerated whole-brain radiotherapy schedules for brain metastases showed no therapeutic gain. The 30 Gy schedule resulted in worse progression-free survival and higher late toxicity compared to historical controls.

Area of Science:

  • Radiation Oncology
  • Neurosurgery
  • Medical Physics

Background:

  • Brain metastases represent a significant clinical challenge.
  • Whole-brain radiotherapy (WBRT) is a common treatment modality.
  • Novel fractionation schedules aim to reduce treatment time and potentially improve outcomes.

Purpose of the Study:

  • To evaluate two novel accelerated fractionation schedules for WBRT in patients with brain metastases.
  • To assess the impact of reduced treatment time and varied total doses on tumor control and toxicity.
  • To compare outcomes with historical standard fractionation.

Main Methods:

  • Two schedules were tested: Schedule 1 (30 Gy in 2 x 2.5 Gy/day) and Schedule 2 (50.4 Gy in 2 x 1.8 Gy/day).
  • Daily fractions were given 6 hours apart, with weekend interruptions.

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  • Schedule 1 was also used adjuvantly for resected metastases.
  • Outcomes were compared to a historical group (3 Gy/day, 30 Gy total).

    • Main Results:

    • Local control, clinical course, and survival were similar between the 30 Gy groups.
    • The 50.4 Gy schedule showed no therapeutic advantage despite favorable patient selection.
    • The accelerated 30 Gy schedule led to significantly worse progression-free survival and increased late radiation toxicity.
    • No severe acute toxicity was observed with the accelerated schedules.

    Conclusions:

    • The accelerated 30 Gy schedule is not recommended due to inferior progression-free survival and increased late toxicity.
    • Higher total dose radiotherapy (50.4 Gy) did not demonstrate any therapeutic benefit.
    • Further research into optimized WBRT fractionation is warranted.