Outcomes after Reirradiation for Brain Metastases

Jesang Yu; Ji Hoon Choi; Sun Young Ma; Taesig Jeung

doi:10.14316/pmp.2015.26.3.137

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Yu, Choi, Ma, and Jeung: Outcomes after Reirradiation for Brain Metastases

Original Article

Progress in Medical Physics 2015;26(3):137-142.

Published online: 20 September 2015

DOI: https://doi.org/10.14316/pmp.2015.26.3.137

Outcomes after Reirradiation for Brain Metastases

Jesang Yu, Ji Hoon Choi, Sun Young Ma, Taesig Jeung

Department of Radiation Oncology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Korea

Correspondence: Ji Hoon Choi (1stdr@naver.com) Tel: 82-51-990-6399, Fax: 82-51-793-0660

Received 1 September 2015 Revised 13 September 2015 Accepted 14 September 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We retrospectively analyzed the outcomes in patients who underwent reirradiation for brain metastasis. Twenty-three patients with brain metastases who were initially treated with palliative brain radiotherapy and were retreated with a second course of brain RT between June 2008 and December 2012. WBRT, 3DCRT and SRS were used for brain metastasis. The median dose of the first course of WBRT was 30 Gy (range, 23.4∼30 Gy). The dose of the first course 3DCRT for lesion was 30 Gy in 3 Gy per fraction. The median dose of the first course of SRS was 16 Gy in 1 fraction (range, 12∼24 Gy). The median dose of the second course of WBRT was 27.5 (range, 12∼30 Gy). The median dose of the second course of 3DCRT for lesion was 30 Gy (range, 25∼30 Gy). The dose of the second course of SRS was 16 Gy in 1 fraction. The second course of WBRT was administered on radiographic disease progression with symptom in all patients. With median follow-up of 25 months, overall symptom resolution rates were 47.8%. Rate of palliative efficacy was 82.6% including stable disease. The median survival time after initiation of reirradiation was 3.2 months. Median value of KPS prior to reirradiation was 30. Median value of KPS after reirradiation was 60. Reirradiation of brain metastasis maybe feasible and effective in select patients with a good performance status KPS≥60 (: ECOG 0∼2) prior to reirradiation.

Keywords: Brain metastasis, Reirradiation, Performance status, KPS

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Fig. 1.

Overall survival after reirradiation. Median overall survival was 3.2 months.

Fig. 2.

Overall survival after reirradiation by KPS. Median overall survival for patients with KPS≥60 were 16 months, and 3 months for patient with KPS＜60.

Fig. 3.

Comparisons of Karnofsky performance status (KPS) for each ReRT patients.

Table 1.

Clinical characteristics of patients.

Parameter	No. of patient (n=23)
Gender
Male	7
Female	16
Age (years)
Median (range)	54 (43∼67)
Primary tumor
Breast	8
Lung
NSCLC	11
SCLC	4
KPS before the reirradiation
100∼70	4
60∼40	7
＜30	12
RPA classification
I	3
II	1
III	19

Table 2.

Radiation therapy details and number of patients.

1^st course of RT	Reirradiation	No. of patients
WBRT	3D CRT	8
	WBRT	3
	SRS	2
3D CRT	3D CRT	2
	WBRT	2
SRS	WBRT	4
	3D CRT	2

Table 3.

Palliative efficacy of treatment.

Response	No. of patient
Relief of symptoms	11 (47.8%)
Stable (maintaining) Aggravation of symtoms	8 (34.8%) 4 (17.4%)

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