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