Prediction of prognosis regarding fractionation schedule and survival in patients with whole-brain radiotherapy for metastatic disease
Meyer, A.; Steinmann, D.; Malaimare, L.; Karstens, J.H.; Bremer, M.
Anticancer Research 28(6b): 3965-3969
2008
ISSN/ISBN: 0250-7005 PMID: 19192657 Document Number: 620522
To look at differences between fractionation schedules regarding established prognostic factors in patients treated with whole-brain radiotherapy (WBRT) for metastasis and actual survival. One hundred and forty-six patients with brain metastases treated with WBRT with three different fractionation schedules with respect to the single dose (SD) 20 x 2.0 Gy (SD2), 15 x 2.5 Gy (SD2.5) and 10 x 3 Gy (SD3) were included. The median overall survival in the SD2, SD2.5 and SD3 groups was 10.3, 10.3 and 5.5 months (p = 0.005) while in recursive partitioning analysis (RPA) classes I, II and III it was 16.7, 8.1 and 3.7 months, respectively (p < 0.0001). Statistically significant variables for overall survival were age (< 60 years, p < 0.0001) and primary site (breast, p = 0.049) in the univariate analysis, and age (p = 0.003) and RPA class (p < 0.0001) in the multivariate analysis. The dose fractionation schedule for WBRT of metastases adequately reflected the clinical estimate of more favourable prognosis. Reduced single doses due to neurocognitive decline may be considered in patients with RPA class I.