title: Radiotherapy for brain metastases: defining palliative response.
abstract: OBJECTIVE
  Most patients with brain metastases are treated with palliative whole brain radiotherapy (WBRT). There is no established definition of palliative response. The aim of this study was to develop and test clinically useful criteria for response following palliative WBRT.
  
  
  METHODS
  A prospective study was conducted of patients with symptomatic brain metastases treated with WBRT (20 Gy/5 fractions) and standardised steroid tapering. Assessments included observer rating of neurological symptoms, patient-completed symptom checklist and performance status (PS). Response criteria were operationally defined based on a combination of neurological symptoms, PS and steroid dose.
  
  
  RESULTS
  Seventy-five patients were accrued. At 1 month, presenting neurological symptoms were improved in 14 patients, stable in 17, and worse in 21; 23 patients were not assessed, mainly due to death or frailty. Using response criteria defined a priori, 15% (95% CI 7-23%) of patients were classified as having a response to RT, 25% no response, and 29% progression; 27% were deceased at or soon after 1 month. A revised set of criteria was tested, with less emphasis on complete tapering of steroids: they increased the proportion of patients responding to 39% (95% CI 27-50%) but didn't change the large proportion who did not benefit (44%).
  
  
  CONCLUSIONS
  Clinical response to RT of patients with brain metastases is multifactorial, comprising symptoms, PS and other factors. Assessment of degree of palliation depend on the exact definition used. More research is needed in this important area, to help validate criteria for assessing palliation after WBRT.
authors.affiliation: Palliative Radiation Oncology Program, Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, M5G 2M9, Toronto, Canada. andrea.bezjak@rmp.uhn.on.ca
authors.forename: A
authors.initials: A
authors.lastname: Bezjak
authors.forename: J
authors.initials: J
authors.lastname: Adam
authors.forename: T
authors.initials: T
authors.lastname: Panzarella
authors.forename: W
authors.initials: W
authors.lastname: Levin
authors.forename: R
authors.initials: R
authors.lastname: Barton
authors.forename: P
authors.initials: P
authors.lastname: Kirkbride
authors.forename: M
authors.initials: M
authors.lastname: McLean
authors.forename: W
authors.initials: W
authors.lastname: Mason
authors.forename: C S
authors.initials: CS
authors.lastname: Wong
authors.forename: N
authors.initials: N
authors.lastname: Laperriere
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010166:Palliative Care; D011379:Prognosis; D011446:Prospective Studies