Whole-brain radiation therapy is not beneficial as an adjuvant therapy for brain metastases compared with localized irradiation.
BACKGROUND
We investigated the role of whole-brain radiation therapy (WBRT) which has been widely used as an adjuvant therapy for brain metastases.


METHODS
The authors retrospectively reviewed 132 patients who underwent surgical resection for brain metastases. They were classified into five groups according to the dose of radiation therapy to the local brain (L) or to the whole-brain (W), independently; 0 Gy (Group A[L or W]), 20-29 Gy (Group B[L or W]), 30-39 Gy (Group C[L or W]), 40-49 Gy (Group D[L or W]) and 50 Gy or more (Group E[L or W]).


RESULTS
Local recurrence rates and times to tumor progression (TTP) of the original tumor were 53% and 3 months for Group A(L), 25% and 6 months for Group C(L), 11% and 7 months for Group D(L) and 12% and 12 months for Group E(L). Median survival times (MST) were 6 months for Group A(L), 8 months for Group C(L), 8 months for Group D(L) and 11 months for Group E(L). Distant recurrence rates and the TTP of new lesions in the distant area were 27% and 7 months for Group A(W), 20% and 6 months for Group B(W), 8% and 9 months for Group C(W), 13% and 13 months for Group D(W) and 4% and 14 months for Group E(W). The MST were 11 months for Group A(W), 11 months for Group B(W), 10 months for Group C(W), 9 months for Group D(W) and 6 months for group E(W).


CONCLUSIONS
The present results suggest that WBRT is unnecessary and that local radiation therapy of 40 Gy or more would be the primary choice of adjuvant therapy for the majority of patients treated with surgical resection for brain metastases.
Iwadate
Yasuo
Y
Department of Neurological Surgery, Chiba University, Graduate School of Medicine, Japan. iwadate@med.m.chiba-u.ac.jp
Namba
Hiroki
H
Yamaura
Akira
A
D000328:Adult; D000368:Aged; D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000556:secondary* / Q000601:surgery; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D015996:Survival Rate