Value of Adding Boost to Whole Brain Radiotherapy after Surgical Resection of Limited Brain Metastasis
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- Category: Vol. 80, March 2012
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Value of Adding Boost to Whole Brain Radiotherapy after Surgical Resection of Limited Brain Metastasis,DALIA H. ZAYED, EMAN H. ELZAHAF and AHMED ZAHER
Abstract
Background and Objective: Brain metastases are the most common intracranial tumors in adults. They affect 20-40% of all cancer patients. Median survival is one month without treatment, two months with steroids, and three to six months with cranial irradiation. The prognosis of patients with limited (1 or 2) brain metastases appears to be better than that of patients with more brain metastases (multiple). This study was done to evaluate the benefit of adding whole brain radio-therapy (WBRT) boost to 1 or 2 brain metastases following its resection and WBRT in patients with recursive partitioning analysis (RPA) class 1 and 2 in comparison to surgical resection and (WBRT).
Patients and Methods: From the period of May 2007 to June 2011, 53 patients with a resectable 1 or 2 brain metastases who attended the Neurosurgical and Clinical Oncology and Nuclear Medicine Departments at Mansoura University & Mansoura Health Insurance Hospital were randomly assigned prospectively.
Patients Eligibility: Patients with 1 or 2 brain metastases diagnosed by computed tomography (CT) and in few patients (7) with magnetic resonance imaging (MRI) with only (RPA) class 1 and 2 were recruited. Further criteria for study inclusion were resectable metastases measuring 4cm and no prior WBRT. Patients were randomly divided into two groups. Group A underwent metastatic surgical resection followed by WBRT using 10 fractions of 3 gray (Gy) each. Group B patients underwent metastatic surgical resection followed by WBRT plus an additional RT boost to the metastatic site (10 fractions of 3Gy each plus a boost of 5 fractions of 3Gy each.
Results: The median overall survival (OS) for Group A was 11 months 95% CI (4.919-17.081) while Group B showed a median OS of 17 months 95% CI (11.004-22.996) which was statistically insignificant (p=0.45). On multivariate analysis of OS, the treatment regimen (p<.001), the extent of resection (p=.002), and KPS (p<.001) were found to maintain statistical significance. The one year local control (LC) was found in 36% (9 patients) in Group A while it was 51.5% (14 patients) in Group B. On multivariate analysis of LC, both treatment regimen, (p<0.001) and extent of surgical resection (p=.016) maintained statistical significance.
Conclusion: After surgical resection of limited brain metastases. A WBRT boost of 15Gy in addition to 30Gy of WBRT appears to improve OS and LC if complete resection has been performed.