Role of palliative radiotherapy in brain metastases

Abstract

Background:Brain metastases are a common manifestation of systemic cancer and exceed primary brain tumors in number and are a significant cause of neurologic problems. They affect 20-40% of all cancer patients. Aggressive management of brain metastases is effective in both symptom palliation and prolonging the life. Radiotherapy has a major role to play in the management of brain metastases.AIM:The aim of the study was to know the outcome of palliative radiotherapy in symptomatic brain metastases in terms of improvement in their performance status.Materials and Methods:This is a retrospective study of 63 patients diagnosed to have brain metastases and treated with palliative whole brain radiotherapy to a dose of 30 Gy in 10 fractions over two weeks between June 1998 and June 2007. Diagnosis was done in most of the cases with computed tomography scan and in a few with magnetic resonance imaging. Improvement in presenting symptoms has been assessed in terms of improvement in their performance status by using the ECOG scale.Results:Fifty-four patients completed the planned treatment. Eight patients received concurrent Temozolamide; 88% of patients had symptom relief at one month follow-up; 39/54 patients had a follow-up of just one to three months. Hence survival could not be assessed in this study.Conclusion:External beam radiotherapy in the dose of 30 Gy over two weeks achieved good palliation in terms improvement in their performance status in 88% of patients. Addition of concurrent and adjuvant Timozolamide may improve the results.

Mechanisms of radiotherapy-associated cognitive disability in patients with brain tumours

“…12 These modes of brain radiotherapy fulfill any of a range of clinical objectives including; (1) long term tumor control or cure as mono or combined therapy, (2) salvage treatment for slowing tumor growth or palliation, and (3) prophylaxis to kill metastatic cells that would otherwise become established in the brain. 6,13-15 …”

Treatment and Prevention of Brain Metastases in Small Cell Lung Cancer

“…Only 15% of cancer patients are diagnosed with a solitary brain metastasis, with cerebral metastases accounting for 85%, cerebellum 10% to 15% and brainstem 1% to 3% of all CNS metastases 17,18. Patients may be asymptomatic or present with headaches, focal neurological symptoms, cognitive changes, ataxia or seizures 17. Treatment of non–small cell lung cancer (NSCLC) CNS metastases has advanced over the last decade moving away from whole brain radiotherapy (WBRT) to stereotactic radiosurgery (SRS) in patients with limited brain metastases 19.…”

“…Central nervous system (CNS) metastases develop in 20% of all cancer patients and risk of developing brain metastases depends on the underlying malignancy, with lung cancer having the highest incidence 16. Only 15% of cancer patients are diagnosed with a solitary brain metastasis, with cerebral metastases accounting for 85%, cerebellum 10% to 15% and brainstem 1% to 3% of all CNS metastases 17,18. Patients may be asymptomatic or present with headaches, focal neurological symptoms, cognitive changes, ataxia or seizures 17.…”