Prospective evaluation of the palliative effect of whole-brain radiotherapy in patients with brain metastases and poor performance status.
OBJECTIVE
The benefit of whole brain radiotherapy (WBRT) for RTOG RPA (Radiation Therapy Oncology Group Recursive Partitioning Analysis) class 3 patients with brain metastases is not well established. The aim of this study was to determine whether WBRT has any benefit in terms of symptoms palliation in such patients. Evaluation of patients' preferences for WBRT, changes in performance and neurological status were secondary aims.


METHODS
Ninety-one RTOG RPA class 3 patients were included. All patients received WBRT (20 Gy in 5 fractions) and were asked to complete a questionnaire about their symptoms before and one month after WBRT. The patient's symptom checklist comprised 17 items scored from 0 to 3; a higher score meant a greater symptom intensity. The mean scores at baseline and after treatment were compared. Karnofsky performance status (KPS) and neurological status before and one month after WBRT were also recorded. Patients were asked to express their preference as to the WBRT undergone.


RESULTS
Forty-three (47%) patients completed both symptom checklists. The mean scores on the symptom checklist were 18.21 and 21.09 at baseline and one month after WBRT, respectively (p = 0.02). The KPS was estimated after WBRT in 42 patients: 57% of patients improved, 26% worsened, and 17% did not change from the baseline KPS score (p = 0.06). Neurological status did not change from baseline to one month after WBRT (p = 0.44). Only 7% of respondents would not have consented to the WBRT undergone.


CONCLUSIONS
Our results challenge the palliative value of the WBRT in RPA class 3 patients.
Komosinska
Katarzyna
K
Department of Radiation Oncology, M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Warsaw, Poland.
Kepka
Lucyna
L
Niwinska
Anna
A
Pietrzak
Lucyna
L
Wierzchowski
Marek
M
Tyc-Szczepaniak
Dobromira
D
Kaczmarczyk
Agnieszka
A
Bujko
Krzysztof
K
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000503:physiopathology / Q000532:radiotherapy* / Q000556:secondary*; D001943:Breast Neoplasms / Q000473:pathology; D016371:Cranial Irradiation / Q000009:adverse effects; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary / Q000473:pathology; D010166:Palliative Care / Q000379:methods*; D011044:Poland; D011446:Prospective Studies; D011879:Radiotherapy Dosage; D011795:Surveys and Questionnaires; D016896:Treatment Outcome