Re-irradiation in the treatment of patients with cerebral metastases of solid tumors: retrospective analysis

Maike Scharp, Henrik Hauswald, Marc Bischof, Juergen Debus, Stephanie E Combs, Maike Scharp, Henrik Hauswald, Marc Bischof, Juergen Debus, Stephanie E Combs

Abstract

Background: Goal of this retrospective analysis was to evaluate the role of repeat whole brain radiotherapy in the palliative care of patients with brain metastases due to solid tumors.

Methods: Data regarding demographic data, primary tumor, metastasis, radiotherapy and symptoms were compiled on 134 patients with cerebral metastases that received repeat whole brain radiotherapy (WBRT) in our clinic between 2002 and 2011.

Results: The analyzed group consisted of 63 (47%) women and 71 (53%) men with a median age of 57 at the start of re-irradiation. Most frequent primary site was the lung (87%).Sixty patients with lung cancer received the first WBRT prophylactically. At the time of re-WBRT 81% of all patients suffered from additional extracerebral metastases.Time between first and second WBRT was a median of 13.4 months. Full dose for the first WBRT was 30 Gy in 2.0 Gy single dose, for the second 20 Gy in 2.0 Gy single dose.At the start of the Re-WBRT 81 patients (60.4%) had mild, 32 (23.9%) severe neurological symptoms, 21 patients (15.7%) were asymptomatic. The median Karnofsky performance status was 70%. Overall, re-WBRT was tolerated satisfactorily. Main side effects were fatigue, erythema and focal alopecia, 10% of patients discontinued treatment before reaching the planned dose. Median survival was 2.8 months since the end of the re-WBRT with good performance status at the start of the re-irradiation being a key indicator for longer survival.Fifty-two patients (39%) showed a clinical improvement of neurological symptoms after the therapy, 59 patients (44%) remained stable, 23 patients (17%) showed worse symptoms.

Conclusions: From this large patient collective we were able to show that re-WBRT can be an important therapeutic option with low rate of acute side effects for patients in adequate general condition.

Figures

Figure 1
Figure 1
Overall survival after re-irradiation (Kaplan-Meier’s estimation).
Figure 2
Figure 2
Overall survival depending on primary tumor site (Kaplan-Meier’s estimation). SCLC with significantly worse prognosis (p = 0.002, log-rank-test).
Figure 3
Figure 3
Overall survival depending on RPA class (Kaplan-Meier’s estimation). RPA class 3 with significantly worse prognosis (p = 0.002, log-rank-test).

References

    1. Soffietti R, Rudà R, Trevisan E. Brain metastases: current management and new developments. Curr Opin Oncol. 2008;20:676–684. doi: 10.1097/CCO.0b013e32831186fe.
    1. Lagerwaard FJ, Levendag PC, Nowak PJ, Eijkenboom WM, Hanssens PE, Schmitz PI. Identification of prognostic factors in patients with brain metastases: a review of 1292 patients. Int J Radiat Oncol Biol Phys. 1999;43:795–803. doi: 10.1016/S0360-3016(98)00442-8.
    1. Gaspar LE, Mehta MP, Patchell RA, Burri SH, Robinson PD, Morris RE, Ammirati M, Andrews DW, Asher AL, Cobbs CS, Kondziolka D, Linskey ME, Loeffler JS, McDermott M, Mikkelsen T, Olson JJ, Paleologos NA, Ryken TC, Kalkanis SN. The role of whole brain radiation therapy in the management of newly diagnosed brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol. 2010;96:17–32. doi: 10.1007/s11060-009-0060-9.
    1. Hauswald H, Dittmar J-O, Habermehl D, Rieken S, Sterzing F, Debus J, Combs SE. Efficacy and toxicity of whole brain radiotherapy in patients with multiple cerebral metastases from malignant melanoma. Radiat Oncol. 2012;7:130. doi: 10.1186/1748-717X-7-130.
    1. Borgelt B, Gelber R, Kramer S, Brady LW, Chang CH, Davis LW, Perez CA, Hendrickson FR. The palliation of brain metastases: final results of the first two studies by the Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys. 1980;6:1–9. doi: 10.1016/0360-3016(80)90195-9.
    1. Ammirati M, Cobbs CS, Linskey ME, Paleologos NA, Ryken TC, Burri SH, Asher AL, Loeffler JS, Robinson PD, Andrews DW, Gaspar LE, Kondziolka D, McDermott M, Mehta MP, Mikkelsen T, Olson JJ, Patchell RA, Kalkanis SN. The role of retreatment in the management of recurrent/progressive brain metastases: a systematic review and evidence-based clinical practice guideline. J Neurooncol. 2010;96:85–96. doi: 10.1007/s11060-009-0055-6.
    1. Akyurek S, Chang EL, Mahajan A, Hassenbusch SJ, Allen PK, Mathews LA, Shiu AS, Maor MH, Woo SY. Stereotactic radiosurgical treatment of cerebral metastases arising from breast cancer. Am J Clin Oncol. 2007;30:310–314. doi: 10.1097/01.coc.0000258365.50975.f6.
    1. Combs SE, Schulz-Ertner D, Thilmann C, Edler L, Debus J. Treatment of cerebral metastases from breast cancer with stereotactic radiosurgery. Strahlenther Onkol. 2004;180:590–596.
    1. Son CH, Jimenez R, Niemierko A, Loeffler JS, Oh KS, Shih HA. Outcomes after whole brain reirradiation in patients with brain metastases. Int J Radiat Oncol Biol Phys. 2012;82:e167–172. doi: 10.1016/j.ijrobp.2011.03.020.
    1. Shehata WM, Hendrickson FR, Hindo WA. Rapid fractionation technique and re-treatment of cerebral metastases by irradiation. Cancer. 1974;34:257–261. doi: 10.1002/1097-0142(197408)34:2<257::AID-CNCR2820340206>;2-6.
    1. Kurup P, Reddy S, Hendrickson FR. Results of re-irradiation for cerebral metastases. Cancer. 1980;46:2587–2589. doi: 10.1002/1097-0142(19801215)46:12<2587::AID-CNCR2820461209>;2-4.
    1. Hazuka MB, Kinzie JJ. Brain metastases: results and effects of re-irradiation. Int J Radiat Oncol Biol Phys. 1988;15:433–437. doi: 10.1016/S0360-3016(98)90026-8.
    1. Cooper JS, Steinfeld AD, Lerch IA. Cerebral metastases: value of reirradiation in selected patients. Radiology. 1990;174:883–885.
    1. Wong WW, Schild SE, Sawyer TE, Shaw EG. Analysis of outcome in patients reirradiated for brain metastases. Int J Radiat Oncol Biol Phys. 1996;34:585–590. doi: 10.1016/0360-3016(95)02156-6.
    1. Abdel-Wahab MM, Wolfson AH, Raub W, Landy H, Feun L, Sridhar K, Brandon AH, Mahmood S, Markoe AM. The role of hyperfractionated re-irradiation in metastatic brain disease: a single institutional trial. Am J Clin Oncol. 1997;20:158–160. doi: 10.1097/00000421-199704000-00011.
    1. Sadikov E, Bezjak A, Yi Q-L, Wells W, Dawson L, Millar B-A, Laperriere N. Value of whole brain re-irradiation for brain metastases–single centre experience. Clin Oncol (R Coll Radiol) 2007;19:532–538. doi: 10.1016/j.clon.2007.06.001.
    1. Harrell, Frank E. Regression Modeling Strategies. Springer; 2002. ISBN 978-1-4757-3462-1.
    1. Tsao MN, Rades D, Wirth A, Lo SS, Danielson BL, Gaspar LE, Sperduto PW, Vogelbaum MA, Radawski JD, Wang JZ, Gillin MT, Mohideen N, Hahn CA, Chang EL. Radiotherapeutic and surgical management for newly diagnosed brain metastasis(es): An American Society for Radiation Oncology evidence-based guideline. Pract Radiat Oncol. 2012;2:210–225. doi: 10.1016/j.prro.2011.12.004.

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