Journal List > Prog Med Phys > v.26(3) > 1098473

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

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.

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Fig. 1.
Overall survival after reirradiation. Median overall survival was 3.2 months.
pmp-26-137f1.tif
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.
pmp-26-137f2.tif
Fig. 3.
Comparisons of Karnofsky performance status (KPS) for each ReRT patients.
pmp-26-137f3.tif
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.
1st 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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