Results of re-irradiation for cerebral metastases

Kurup, Parvathy D.; Reddy, Salitha; Hendrickson, Frank R.

doi:10.1002/1097-0142(19801215)46:12<2587::aid-cncr2820461209>3.0.co;2-4

Cited by 75 publications

(29 citation statements)

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“…Chemotherapy and WBRT were compared in eight studies 7,8,[55][56][57][58][59][60] . Five trials examined the efficacy of whole-brain re-irradiation in patients with brain metastases [61][62][63][64][65] . One study randomized patients with 1-3 brain metastases to WBRT or WBRT followed by stereotactic radiosurgery boost 18 .…”

Section: Multiple Brain Metastasesmentioning

confidence: 99%

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Quality of Life in Brain Metastases Radiation Trials: A Literature Review

et al. 2008

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BackgroundAn estimated 20%-40% of cancer patients will develop brain metastases. Whole-brain radiotherapy (WBRT) is the standard treatment for patients with brain metastases. Although WBRT can reduce neurologic symptoms, the median survival following WBRT is between 3 and 6 months. Given this limited survival, it is important to consider quality of life (QOL) when treating patients with brain metastases. However, few studies have focused on QOL and improvement in patient-rated symptoms as primary outcomes. ObjectiveFor an accurate measurement of the extent to which previous trials have utilized QOL tools to evaluate the efficacy of WBRT for treatment of brain metastases, we undertook a literature review to examine the common endpoints and QOL instruments used. MethodsWe conducted a systematic search using the MEDLINE (1950( to December 2007 and Cochrane Central Register of Controlled Trials (4th quarter 2007) databases. Eligible studies investigated WBRT in one of the study arms. The following outcomes were included: median survival, overall survival, neurologic function, 1-year local control, and overall response; use of QOL instruments, performance status scales, and neurologic function assessments; and use of other assessment tools. Patient-rated QOL instruments were defined as those that strove to assess all dimensions of QOL; observerrated performance instruments such as the Karnofsky performance status (KPS) were deemed to be performance scales. ResultsWe identified sixty-one trials that included WBRT nine evaluated the treatment of a single brain metastasis, and fifty-two evaluated the treatment of multiple brain metastases. Although fifty-five of the trials employed a QOL instrument, few trials focused on QOL as an outcome. We found 23 different instruments used to evaluate QOL. The most commonly employed instrument was the KPS (n = 33), followed by various neurologic function classification scales (n = 21). A preponderance of the studies used 1 (n = 26, 43%) or 2 (n = 21, 34%) QOL instruments.A total of fourteen published trials on brain metastases included an evaluation of the study population's QOL. Those trials included three that used the Functional Assessment of Cancer Therapy-General scale and Brain subscale instrument, three that used the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (C30) and the Brain Cancer Module 20 instrument, two that used study-designed QOL instruments, one that used the Edmonton Symptom Assessment Scale, two that used the Spitzer Quality of Life index, and three that used the KPS to evaluate QOL. Some trials reported deterioration in QOL after WBRT in patients with poorer prognosis; other trials detected an improvement in QOL after WBRT in patients with better prognosis. ConclusionsTo date, fourteen trials in brain metastases that have included an evaluation of the study population's QOL have been published. Although some studies showed that certain parameters of QOL deteriorate after WBRT, other studies showed that Q...

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Section: Multiple Brain Metastasesmentioning

confidence: 99%

“…Six studies did not use any QOL measures 20,43,[60][61][62]78 . The most commonly used instruments were the KPS scale (n = 33) and various forms of neurologic function classification (n = 21).…”

Section: Qol Instrumentsmentioning

confidence: 99%

Quality of Life in Brain Metastases Radiation Trials: A Literature Review

et al. 2008

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“…While a median OS from the time of repeat RT of 2.7 months is low, it is comparable to most other reirradiation series (Table 4) [6][7][8][9][10][11][12][13]. Notwithstanding the substantial limitations of small retrospective subgroup analysis, we performed an exploratory subgroup analysis and eliminated patients with known poor prognostic histologies (melanomas and small cell lung cancers); the 11 remaining patients were found to have a crude median OS of 6.7 months (Table 3).…”

Section: Discussionmentioning

confidence: 52%

“…The application of this novel technique for the treatment of the whole brain is exciting and may carry promise for further evaluation. Unlike upfront management of brain metastases patients, the literature is relatively limited for guiding treatment of patients with intracranial relapse after WBRT [6][7][8][9][10][11][12][13], despite its occurrence in 47-86% of patients [5]. Furthermore, recommendations are often conflicting, and the existing series span decades over which patient survival and RT delivery techniques have changed significantly [6][7][8][9][10][11][12][13].…”

Section: Discussionmentioning

confidence: 99%

“…Potential interventions after WBRT include surgical resection, chemotherapy, SRS, or repeat WBRT. The radiation dose given at the time of repeat WBRT generally is reduced secondary to toxicity concerns and ranges from 20 to 30 Gy [6][7][8][9][10][11][12][13]. This only provides limited biologic effect on gross disease, yet still carries a substantial risk for neurocognitive delay to the patient.…”

Section: Introductionmentioning

confidence: 99%

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Repeat Whole Brain Radiation Therapy with a Simultaneous Infield Boost: A Novel Technique for Reirradiation

Hall

Prabhu

Crocker

et al. 2014

Journal of Radiotherapy

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The treatment of patients who experience intracranial progression after whole brain radiation therapy (WBRT) is a clinical challenge. Novel radiation therapy delivery technologies are being applied with the objective of improving tumor and symptom control in these patients. The purpose of this study is to describe the clinical outcomes of the application of a novel technology to deliver repeat WBRT with volume modulated arc therapy (VMAT) and a simultaneous infield boost (WB-SIB) to gross disease. A total of 16 patients were initially treated with WBRT between 2000 and 2008 and then experienced intracranial progression, were treated using repeat WB-SIB, and were analyzed. The median dose for the first course of WBRT was 35 Gy (range: 30-50.4 Gy). Median time between the initial course of WBRT and repeat WB-SIB was 11.3 months. The median dose at reirradiation was 20 Gy to the whole brain with a median boost dose of 30 Gy to gross disease. A total of 2 patients demonstrated radiographic disease progression after treatment. The median overall survival (OS) time from initial diagnosis of brain metastases was 18.9 months (range: 7.1-66.6 (95% CI: 0.8-36.9)). The median OS time after initiation of reirradiation for all patients was 2.7 months (range: 0.46-14.46 (95% CI: 1.3-8.7)). Only 3 patients experienced CTCAE grade 3 fatigue. No other patients experienced any ≥ CTCAE grade 3 toxicity. This analysis reports the result of a novel RT delivery technique for the treatment of patients with recurrent brain metastases. Side effects were manageable and comparable to other conventional repeat WBRT series. Repeat WB-SIB using the VMAT RT delivery technology is feasible and appears to have acceptable short-term acute toxicity. These results may provide a foundation for further exploration of the WB-SIB technique for repeat WBRT in future prospective clinical trials.

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