Short-course whole-brain radiotherapy (WBRT) for brain metastases due to small-cell lung cancer (SCLC)

Bohlen, Guenther; Meyners, Thekla; Kieckebusch, Susanne; Lohynska, Radka; Veninga, Theo; Stalpers, Lukas J.A.; Schild, Steven E.; Rades, Dirk

doi:10.1016/j.clineuro.2009.11.004

« Previous Next »Clinical Neurology and Neurosurgery
Volume 112, Issue 3 , Pages 183-187, April 2010

Short-course whole-brain radiotherapy (WBRT) for brain metastases due to small-cell lung cancer (SCLC)

Guenther Bohlen
- Department of Radiation Oncology, University of Lubeck, Lubeck, Germany
Thekla Meyners
- Department of Radiation Oncology, University of Lubeck, Lubeck, Germany
Susanne Kieckebusch
- Department of Radiation Oncology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
Radka Lohynska
- Department of Radiation Oncology, University Hospital, Prague, Czech Republic
Theo Veninga
- Department of Radiotherapy, Dr. Bernard Verbeeten Institute, Tilburg, The Netherlands
Lukas J.A. Stalpers
- Department of Radiotherapy, Academic Medical Center, Amsterdam, The Netherlands
Steven E. Schild
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA
Dirk Rades
- Department of Radiation Oncology, University of Lubeck, Lubeck, Germany
- Corresponding author at: Department of Radiation Oncology, University Hospital Schleswig-Holstein, Campus Lubeck, Ratzeburger Allee 160, D-23538 Lubeck, Germany. Tel.: +49 451 500 6661; fax: +49 451 500 3324.

Received 3 May 2009; received in revised form 4 November 2009; accepted 6 November 2009.

Abstract

Objective

Many patients with brain metastases due to SCLC have a poor survival prognosis. The most common treatment is whole-brain radiotherapy (WBRT). This retrospective study compares short-course WBRT with 5×4Gy in 1 week to standard WBRT with 10×3Gy in 2 weeks.

Methods

Forty-four SCLC patients receiving WBRT with 5×4Gy were compared to 102 patients receiving 10×3Gy for survival (OS) and local (intracerebral) control (LC). Seven further potential prognostic factors were investigated: age, gender, Karnofsky Performance Score (KPS), number of brain metastases, extracerebral metastases, interval from tumor diagnosis to WBRT, RPA (Recursive Partitioning Analysis) class.

Results

After 5×4Gy, 12-month OS was 15%, versus 22% after 10×3Gy (p=0.69). On multivariate analysis, improved OS was associated with age ≤60 years (p=0.013), KPS ≥70 (p<0.001), <4 brain metastases (p=0.011), and RPA class 1 (p<0.001). 12-month LC was 34% after 5×4Gy versus 25% after 10×3Gy (p=0.32). On multivariate analysis, improved LC was associated with KPS ≥70 (p<0.001), <4 brain metastases (p=0.027), and RPA class 1 (p<0.001).

Conclusion

In patients with brain metastases due to SCLC, short-course WBRT with 5×4Gy provided similar outcomes as 10×3Gy and appears preferable, particularly for patients with poor estimated survival.

Keywords: Brain metastases, Small-cell lung cancer, Palliative treatment, Whole-brain radiotherapy, Overall survival, Local control