Abstract
PurposeTo evaluate the prognostic factors associated with overall survival in patients with brain metastasis treated with whole brain radiotherapy (WBRT) and estimate the potential improvement in survival for patients with brain metastases, stratified by the Radiation Therapy Oncology Group (RTOG) recursive partitioning analysis (RPA) class.Patients and methodsFrom January 1996 to December 2000, 270 medical records of patients with diagnosis of brain metastasis, who received WBRT in the Hospital do Cancer Sao Paulo A.C. Camargo in the period, were analyzed. The surgery followed by WBRT was used in 15% of patients and 85 % of others patients were submitted at WBRT alone; in this cohort 134 patients (50%) received the fractionation schedule of 30 Gy in 10 fractions. The most common primary tumor type was breast (33%) followed by lung (29%), and solitary brain metastasis was present in 38.1% of patients. The prognostic factors evaluated for overall survival were: gender, age, Karnofsky Performance Status (KPS), number of lesions, localization of lesions, primary tumor site, surgery, chemotherapy, absence extracranial disease, RPA class and radiation doses and fractionation.ResultsThe OS in 1, 2 and 3 years was 25, 1%, 10, 4% e 4, 3% respectively, and the median survival time was 4.6 months. The median survival time in months according to RPA class after WBRT was: 6.2 class I, 4.2 class II and 3.0 class III (p < 0.0001). In univariate analysis, the significant prognostic factors associated with better survival were: KPS higher than 70 (p < 0.0001), neurosurgery (p < 0.0001) and solitary brain metastasis (p = 0.009). In multivariate analysis, KPS higher than 70 (p < 0.001) and neurosurgery (p = 0.001) maintained positively associated with the survival.ConclusionIn this series, the patients with higher perform status, RPA class I, and treated with surgery followed by whole brain radiotherapy had better survival.This data suggest that patients with cancer and a single metastasis to the brain may be treated effectively with surgical resection plus radiotherapy. The different radiotherapy doses and fractionation schedules did not altered survival.
Highlights
Brain metastases represent an important cause of morbidity and mortality, and are the most common intracranial tumors in adults, occurring in approximately 10% to 30% of adult cancer patients [1]
This data suggest that patients with cancer and a single metastasis to the brain may be treated effectively with surgical resection plus radiotherapy
The risk of developing brain metastases varies according to primary tumor type, with lung cancer accounting for approximately one half of all brain metastases [2]
Summary
Brain metastases represent an important cause of morbidity and mortality, and are the most common intracranial tumors in adults, occurring in approximately 10% to 30% of adult cancer patients [1]. The prognosis of patients with brain metastases is poor; the median survival time of untreated patients is approximately 1 month [3]. The most widely used treatment for patients with multiple brain metastases is WBRT. The appropriate use of WBRT can provide rapid attenuation of many neurological symptoms, improve quality of life, and is especially beneficial in patients whose brain metastases are surgically inaccessible or when other medical considerations remove surgery from the list of appropriate options [6,7]. The use of adjuvant WBRT after resection or radiosurgery has been proven to be effective in terms of improving local control of brain metastases, and the likelihood of neurological death is decreased [8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
