Whole-brain Radiotherapy With or Without a Simultaneous Integrated Boost for Treatment of Brain Metastases

Abstract

Background/aim: Many patients with brain metastases receive whole-brain radiotherapy (WBRT), despite the increasing use of stereotactic radiotherapy alone. A more recent approach includes WBRT combined with simultaneous integrated boost (WBRT+SIB). This study compared WBRT alone and WBRT+SIB for unresected brain metastases.

Patients and methods: One-hundred-and-three patients receiving WBRT+SIB were compared to 275 patients receiving WBRT alone for intracerebral control (IC) and overall survival (OS).

Results: Both treatment groups (WBRT alone and WBRT+SIB) were balanced with respect to patient characteristics. On multivariate analyses, WBRT+SIB (p=0.041), Karnofsky performance score (KPS) >70 (p<0.001), and 1-3 brain metastases (p=0.016) were significantly associated with IC. KPS >70 (p<0.001), favorable tumor type (p=0.011), 1-3 brain metastases (p=0.011), and absence of extracranial metastases (p<0.001) were significantly associated with OS.

Conclusion: WBRT+SIB is associated with improved IC but similar OS when directly compared to WBRT for brain metastases. Selected patients with a high risk of intracerebral recurrence may benefit from SIB.

Keywords: Unresected brain metastases; intracerebral control; overall survival; simultaneous integrated boost; whole-brain radiotherapy.