OP0009 Comparison of two fractionation schedules on quality of life and survival in patients with brain metastases: A randomised, double-blind trial

Abstract

Background Different radiation fractionation schedules are used to treat brain metastases. Optimally fractionated radiotherapy is necessary for a highly populated country with limited resources like India. We compared two fractionation schedules in terms of survival and quality of life. Methods 186 patients with radiologically proven brain metastases were randomised (1:1) to receive radiotherapy at 20 Gy in five fractions or 30 Gy in 10 fractions. Results 93 patients were assigned to each group. All patients completed the treatment without interruption. 90% had at least one follow-up visit, and others were telephoned and censored for the survival analysis. Lung cancer was the most common primary cancer and the mean KPS of the population was 70. Median overall survival was comparable between the two groups (88 days versus 85 days). Overall survival at 6 months was 32.3%.The mean technical delay (due to limited resources) in starting radiation was 5.7 days. Better overall survival was noted for patients aged younger than 65 years ( p = 0.02) with good KPS (⩾70; p p = 0.027).Overall survival was also improved for patients who received adjuvant chemotherapy or targeted treatment. Better survival was noted for patients with breast cancer when compared with those with lung cancer (170 days versus 86 days; p = 0.017) and for patients with KPS ⩾70 at presentation. Similarly, patients with fewer than three metastases had better survival ( p = 0.016). Survival analysis by RTOG RPA classes showed better survival for patients in the good prognosis group, although the difference was not significant (class 1: 124 days, class 2: 89 days, class 3: 55 days; p = 0.26). Mean KPS had reduced from 69 to 26 at 6 months. However, KPS in living patients progressively improved at 1, 3, and 6 months (mean 69, 78, and 86 respectively). The improvement in KPS after whole brain radiotherapy was similar in both groups ( p = 0.68). Interpretation In a highly populated country like India with limited resources, 20 Gy in five fractions is a feasible radiotherapy schedule with comparable overall survival and good KPS compared with a longer fractionation schedule. Using this schedule, overall treatment duration could be reduced and more patients can be cared for with available resources.