Prediction of prognosis regarding fractionation schedule and survival in patients with whole-brain radiotherapy for metastatic disease.
OBJECTIVE
To look at differences between fractionation schedules regarding established prognostic factors in patients treated with whole-brain radiotherapy (WBRT) for metastasis and actual survival.


METHODS
One hundred and forty-six patients with brain metastases treated with WBRT with three different fractionation schedules with respect to the single dose (SD) 20 x 2.0 Gy (SD2), 15 x 2.5 Gy (SD2.5) and 10 x 3 Gy (SD3) were included.


RESULTS
The median overall survival in the SD2, SD2.5 and SD3 groups was 10.3, 10.3 and 5.5 months (p = 0.005) while in recursive partitioning analysis (RPA) classes I, II and III it was 16.7, 8.1 and 3.7 months, respectively (p < 0.0001). Statistically significant variables for overall survival were age (< 60 years, p < 0.0001) and primary site (breast, p = 0.049) in the univariate analysis, and age (p = 0.003) and RPA class (p < 0.0001) in the multivariate analysis.


CONCLUSIONS
The dose fractionation schedule for WBRT of metastases adequately reflected the clinical estimate of more favourable prognosis. Reduced single doses due to neurocognitive decline may be considered in patients with RPA class I.
Meyer
Andreas
A
Department of Radiation Oncology, Medical School Hannover, 30625 Hannover, Germany. Meyer.A@mh-hannover.de
Steinmann
Diana
D
Malaimare
Liliana
L
Karstens
Johann H
JH
Bremer
Michael
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D001943:Breast Neoplasms / Q000473:pathology / Q000532:radiotherapy; D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000532:radiotherapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate