Equivalence of radiation schedules for the palliative treatment of brain metastases in patients with favorable prognosis

Abstract

Five whole-brain irradiation schedules ranging from 2000 rad in one week to 4000 rad in four weeks were evaluated in 1830 patients with cerebral metastases treated in two randomized studies by the Radiation Therapy Oncology Group. The duration of palliative effectiveness among those patients with favorable survival prognosis was investigated. Favorable subgroups were identified consisting of 123 ambulatory breast cancer patients with no soft tissue metastases, 373 ambulatory lung cancer patients with primary absent or no extracerebral metastases, and 65 ambulatory patients with other primaries and no extracerebral metastases. This group of 561 patients had a median survival of 28 weeks compared with 11 weeks for the remaining patients. Analyses of neurologic function control rates failed to show a significant benefit of higher doses. No advantage was demonstrated for treating brain metastases patients with favorable prognoses with more than one week of whole-brain irradiation.