Palliative Radiotherapy For Brain Metastases Research Articles

Retrospective evaluation of radiotherapy techniques in the management of patients with brain metastasis: A single-center Experience

Introduction: The aim of this study was to evaluate the demographic characteristics and radiotherapy schedules of patients for whom palliative radiotherapy for brain metastasis was administered. Methods: This was a retrospective study that evaluated the patients who received palliative radiotherapy for brain metastases between January 2011 and December 2019. Patient treatment files and the hospital information management system were used to collect the data. Results: In this study, 4107 patients who received radiotherapy for any brain tumors were evaluated. Of these, 2910 had metastatic brain tumors. In the metastatic group 1736 (60%) patients were male and 1174 (40%) were female. Primary diagnosis was lung cancer (38%), breast cancer (20%), primary unknown (15%), gastrointestinal cancers (12%), and other cancers (15%). 1643 (52%) patients received whole-brain radiotherapy (WBRT), 535 (18%) received WBRT with stereotactic radiosurgery (SRS) and 706 (29%) received SRS without WBRT for brain metastasis. Radiotherapy data of 26 (1%) patients could not be accessed. Conclusion: Both WBRT and SRS are good palliative treatment options for brain metastasis. SRS without WBRT can be considered as a treatment option in selected cases.

Acute neurologic toxicity of palliative radiotherapy for brain metastases in patients receiving immune checkpoint blockade.

The interaction between immune checkpoint blockade (ICB) and radiation (RT) for brain metastases has not been well understood. Given that acute neurotoxicity from this combination is not well characterized, we reviewed patients receiving ICB and RT for brain metastases. Patients treated with ICB and cranial RT from 2010 through 2017 were reviewed. ICB and RT must have been administered within 30 days of each other. Treatment parameters, performance status, symptoms prior to treatment, and toxicity were extracted from the electronic medical record. Survival was calculated from the end of RT to last follow-up or death. Seventy-eight patients were included. Median follow-up was 177 days (range, 12-1603). Median age was 64 years old (range, 29-98) and 47 (63%) were male. The main tumor types were melanoma (n = 47) and nonsmall-cell lung cancer (n = 19). Fifty-seven patients were treated with stereotactic radiosurgery (SRS) and 21 with whole-brain radiotherapy (WBRT). Most patients received single-agent ICB, though 4 patients received nivolumab and ipilimumab. Forty-one (53%) patients reported no neurologic toxicity. Grade 2 or greater neurologic toxicities were reported in 12 (21%) and 8 (38%) patients in the SRS and WBRT groups, respectively. WBRT was associated with a greater risk of any neurotoxicity, though there was no correlation between ICB agent and toxicity. Sequencing of ICB and RT (ie, <30 days vs <7) did not influence rates of toxicity. ICB during SRS or WBRT does not appear to worsen acute neurotoxicity compared to historical controls of RT alone.

Prospective evaluation of quality of life effects in patients undergoing palliative radiotherapy for brain metastases

BackgroundRecently published results of quality of life (QoL) studies indicated different outcomes of palliative radiotherapy for brain metastases. This prospective multi-center QoL study of patients with brain metastases was designed to investigate which QoL domains improve or worsen after palliative radiotherapy and which might provide prognostic information.MethodsFrom 01/2007-01/2009, n=151 patients with previously untreated brain metastases were recruited at 14 centers in Germany and Austria. Most patients (82 %) received whole-brain radiotherapy. QoL was measured with the EORTC-QLQ-C15-PAL and brain module BN20 before the start of radiotherapy and after 3 months.ResultsAt 3 months, 88/142 (62 %) survived. Nine patients were not able to be followed up. 62 patients (70.5 % of 3-month survivors) completed the second set of questionnaires. Three months after the start of radiotherapy QoL deteriorated significantly in the areas of global QoL, physical function, fatigue, nausea, pain, appetite loss, hair loss, drowsiness, motor dysfunction, communication deficit and weakness of legs. Although the use of corticosteroid at 3 months could be reduced compared to pre-treatment (63 % vs. 37 %), the score for headaches remained stable. Initial QoL at the start of treatment was better in those alive than in those deceased at 3 months, significantly for physical function, motor dysfunction and the symptom scales fatigue, pain, appetite loss and weakness of legs. In a multivariate model, lower Karnofsky performance score, higher age and higher pain ratings before radiotherapy were prognostic of 3-month survival.ConclusionsModerate deterioration in several QoL domains was predominantly observed three months after start of palliative radiotherapy for brain metastases. Future studies will need to address the individual subjective benefit or burden from such treatment. Baseline QoL scores before palliative radiotherapy for brain metastases may contain prognostic information.

Short Survival After Palliative Radiotherapy for Brain Metastases in Lung Cancer

People with lung cancer (LCa) and symptomatic metastatic disease deserve palliative radiotherapy to promote a better quality of remaining life. On the other hand, in the case being described that of a LCa patient with brain and spinal metastases who died shortly after irradiation-- could management consisting of hospice and/or supportive care have been a better choice? Prognostic factors were analyzed in this retrospective study of the early deaths of 20 LCa patients with brain metastases in order to assist in a more rational decision making regarding treatment.

56 DOSIMETRIC TREATMENT EVALUATION AND OPTIMIZED REPLANNING FOR IMRT OF CERVIX CANCER

Purpose: Palliative Radiotherapy (PRT) plays an important role in the relief of neurologic symptoms in patients with brain metastases; however, little is known about the use of PRT on a population level. The purpose of this study was to describe temporal trends in the use of PRT for brain metastases in Ontario. Methods: The Ontario Cancer Registry was used to gather information on all cancer deaths in Ontario between the years 1984-2004. The proportion of these cases receiving at least one course of PRT for bone metastases within the last two years of life was described over time and by disease site. Results: There were 435,055 cancer deaths in Ontario during the study period. Of these cases, 4.0% received at least one course of PRT for brain mets within the last two years of life. The rate of PRT varied significantly by primary site (e.g. lung8.7%, breast-6.4%, kidney-5.0%, prostate-0.6%) (p<0.001). Over time, the proportion of cases receiving PRT for brain mets increased from 2.1% to 5.0% (p<0.001). This increasing trend remained significant after taking into account primary site, age, sex, and time from diagnosis till death (p<0.001). The rate over time also varied by primary site (e.g. lung5.3% to 11.2%, breast3.7% to 8.8%, kidney2.2% to 6.0%, prostate0 to 0.9%) (p<0.001). Conclusion: The rate of PRT for brain metastases in Ontario has significantly increased over time. Explanations for these trends will be discussed.

Effects of Radiotherapy for Brain Metastases on Quality of Life (QoL)

Prospective data on quality-of-life (QoL) effects of radiotherapy for brain metastases are currently lacking, but would be of great interest to guide therapeutic decisions. From 01/2007 to 08/2007, 46 patients with previously untreated brain metastases were recruited at eight centers. QoL was measured at start of treatment (T(0)) and at 3 months (T(3mo)). In the pilot study, two combinations of QoL instruments could be used at the discretion of the centers (A: EORTC QLQ-C30 and B: EORTC QLQ-C15-PAL both with brain module BN20, assessment by proxies with A: Palliative Care Outcome Scale, B: self-constructed brain-specific instrument). All patients received whole-brain radiotherapy, four with an additional boost irradiation. At T(3mo), 26/46 patients (56.5%) had died. 17/20 survivors (85%) completed the questionnaires. In 3-month survivors, QoL deteriorated in most domains, significant in drowsiness, hair loss and weakness of legs. The scores for headaches and seizures were slightly better after 3 months. Assessment by proxies also suggested worsening of QoL. Initial QoL at T(0) was better in those alive than in those deceased at T(3mo), significant for physical function and for the symptom scales of fatigue and pain, motor dysfunction, communication deficit and weakness of legs. Practicability and compliance appeared better with the (shorter) version B. This version is now used in the ongoing main phase of the study with additional centers. First results indicate a moderate worsening of QoL during the first 3 months after start of palliative radiotherapy for brain metastases. QoL at initiation of radiotherapy may be prognostic for survival.

Referring Physicians' Expectations of Palliative Radiotherapy for Brain Metastases

Referring Physicians' Expectations of Palliative Radiotherapy for Brain Metastases

Palliative Radiation Therapy in the Management of Brain Metastases, Spinal Cord Compression, and Bone Metastases

Radiation therapy plays an important role in both curative and palliative cancer treatment. Palliative radiation therapy is given to alleviate symptoms, restore function, relieve suffering caused by cancer, and improve quality of life. Pain relief, control of bleeding or ulceration, prevention of impending compression or obstruction from tumor, and shrinkage of tumor masses causing symptoms are indications for palliative radiotherapy. Palliative radiotherapy is a very effective tool in alleviating pain symptoms and generally well tolerated. Common fractionation schemes are 8 Gy delivered in one fraction and 30 Gy delivered in 10 fractions. This article discusses general principles of administering palliative radiation therapy. Site-specific treatment is addressed, divided into palliative radiotherapy for brain metastases, spinal cord compression, and bone metastases. In each of these areas, we discuss presentation, management, and therapeutic strategies.

Prospective Assessment of Patient-Rated Symptoms Following Whole Brain Radiotherapy for Brain Metastases

To prospectively assess patient-rated symptoms in patients with brain metastases treated with whole brain radiotherapy, these patients were asked to rate their symptoms on the Edmonton Symptom Assessment Scale (ESAS) before, and 1, 2, 4, 8, and 12 weeks following the radiation treatment. ESAS evaluates pain, fatigue, nausea, depression, anxiety, drowsiness, appetite, sense of well-being, and shortness of breath on a scale of 0–10 (0 = absence of symptom and 10 = worst possible symptom). Patients with a language barrier or significant cognitive impairment were excluded. The mean difference of ESAS symptoms at each follow up were compared with baseline and P < 0.01 was considered statistically significant. One hundred seventy patients (102 female and 68 male) were included between January 1999 and January 2002. Their median age was 66 years (range 33–84) and the median Karnofsky performance score (KPS) at baseline was 60 (range 20–90). The most common primary cancer sites were lung (99; 58%), breast (32; 19%), gastrointestinal (16; 9%), unknown (14; 8%) and others (9; 6%). One-third had significant weight loss (≥10% over the last 6 months). All patients were prescribed dexamethasone at varying doses during radiotherapy. The dose fractionations were 20 Gy in 5 fractions, 138 (81%); 30 Gy in 10 fractions, 7 (4%); and others, 25 (15%). The baseline mean ± SD for ESAS scores were: pain 2.4 ± 2.8, fatigue 5.3 ± 2.8, nausea 1.3 ± 2.2, depression 2.8 ± 2.7, anxiety 3.6 ± 3.0, drowsiness 3.5 ± 2.9, appetite 3.0 ± 3.2, sense of well-being 3.8 ± 2.7, and shortness of breath 2.3 ± 2.5. For the entire cohort, after the delivery of palliative radiotherapy for brain metastases, there were statistically significant deteriorations in the mean differences from the baseline for the following ESAS domains: fatigue 1.0 to 1.8; drowsiness 1.2 to 1.8; and appetite 2.2 to 2.4. The data demonstrate that certain parameters of quality of life worsen after whole brain radiotherapy.

Radiation therapy in the management of brain metastases from breast cancer.

A retrospective analysis of 99 patients treated at Radiumhemmet, Karolinska Hospital 1979-1990 with palliative radiotherapy for brain metastases from breast cancer was performed. A relief of symptoms was obtained in 45% of patients. Median time from diagnosis of breast cancer until CNS metastases was 33 months. Median survival time with CNS metastases after diagnosis was 5 months. Prognostic indicators for survival were studied. Patients operated for a singular brain metastasis and irradiated postoperatively had a mean survival of 21 months while patients with multiple brain metastases and meningeal spread displayed a short median survival. Extracranial disease status influenced prognosis significantly. Radiation dose (CRE) did not correlate with survival.

Palliative radiotherapy for brain metastases in renal carcinoma

Between 1968 and 1985, 46 patients with renal cell carcinoma metastatic to the brain parenchyma were treated with radiation. Thirty-nine received whole-brain radiation, mostly 30 Gy in ten fractions. Symptoms improved in 30% of evaluable patients. Partial regression of metastases was documented in two of 11 available sequential computed tomographs (CT) of the brain. Seven patients were treated with surgery and postoperative radiation. In five the excision was complete and associated with clinical improvement. All 46 patients have subsequently died. The median survival time of the entire group was 8 weeks. The ten patients who improved after radiotherapy survived for a median of 17 weeks. Two additional patients were treated in 1986 with fast neutrons; both had a documented maintained complete response. Brain metastasis in renal carcinoma carries a poor prognosis. It is usually unresponsive to conventional photon therapy. In selected cases an alternative treatment with surgery or neutron therapy should be considered.