Clinical Factors Asssociated with Treatment Outcomes following Whole-brain Irradiation in Patients with Prostate Cancer

Abstract

Abstract. Background Metastases to the brain represent a palliative situation that occurs in up to 40% of patients with cancer (1-3). The most common primary tumors associated with brain metastases are lung cancer (40-50%) and breast cancer (20-25%). In contrast, patients with prostate cancer account for a minority of less than 1%. Therefore, there is a considerable lack of data regarding this group. Many patients with metastases to the brain from prostate cancer have a short expected survival and are treated with whole-brain irradiation (WBI) alone.When a patient is assigned to WBI, several options, i.e. dose-fractionation programs, are available (2, 3). These options range from 1-week programs with lower total doses and higher doses per fraction to more protracted programs lasting up to 4 weeks with higher total doses but lower doses per fraction. Previous studies of WBI for brain metastases from different tumor types suggested that patients with a short expected survival should be treated with a short WBI program to allow the patients to spend more of their remaining time at home (2, 4). In contrast, longer WBI programs were reported to result in improved local (intracerebral) control and survival in the group of patients with the longest estimated survival time (5).Thus, it is important to be able to judge a patient's remaining survival time before assigning them to a WBI program. Therefore, this study was performed with the major goal as the identification of possible independent predictors of survival, and additionally of local control in patients with metastases to the brain from prostate cancer. Identification of such predictors would assist the treating physicians when choosing the most appropriate WBI program for such a patient. Patients and MethodsIn this retrospective study, 18 unselected patients with prostate cancer treated with WBI for metastases to the brain were included. The major goal of this study was the evaluation of possible associations between local (intracerebral) control and survival and seven clinical factors. These factors were the WBI fractionation program (4 Gy × 5 vs. 3 Gy × 10), age at WBI (<75 vs. ≥75 years, median=74.5 years), Karnofsky performance score (KPS) (≤70% vs. 80%), number of metastases to the brain (<4 vs. ≥4), involvement of extracerebral metastatic sites (none vs. bone only vs. sites other than bone), time interval from prostate cancer diagnosis to WBI (≤28 vs. >28 months), and recursive partitioning analysis (RPA) class (2 vs. 3) (6). The distribution of these factors is shown in Table I. Univariate analyses of local control and survival were carried out 35

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