title: Whole brain radiotherapy: prognostic factors and results of a radiation boost delivered through a conventional linear accelerator.
abstract: OBJECTIVE
  Assess prognostic factors for overall survival and the potential benefit of a boost in patients treated with whole brain radiation therapy (WBRT).
  
  
  METHODS
  From 2002 to 2006, a retrospective analysis was made from 250 unselected consecutive patients with secondary brain metastases from lung cancer, breast cancer and melanoma. Eighteen patients received surgery and were excluded from analysis. Four potential prognostic factors have been studied: primary tumor type, gender, number of metastases and improvement of neurological symptoms after radiation therapy. A subgroup analysis was performed to determine whether an additional boost could potentially improve outcome in patients who presented with less than three metastases, performance status <2, and no surgical resection of their metastasis.
  
  
  RESULTS
  Average follow-up was 10.3 months. Median overall survival was 5.6 months and survival rates at 1 and 2 years were 22.7% and 10%, respectively. Age less than 65 (p<0.01), neurological improvement after WBRT (p<0.01), and presence of less than three metastases were significant factors for overall survival in multivariate analysis. When focusing on the selected subgroup (120 assessable patients), median overall survival was 4.0 months in patients with no radiation boost, versus 8.9 months in patients with radiation boost (p=0.0024).
  
  
  CONCLUSIONS
  Survival and prognostic factors were similar to those found in the literature. Boost delivered after WBRT by a conventional particle accelerator could provide a benefit in selected patients, especially for centers that do not have radiotherapy techniques in stereotactic conditions. This warrants further prospective assessment.
authors.affiliation: Department of Radiation Oncology, Pitie Salpetriere University Hospital, University Paris VI, France. avi.assouline@psl.aphp.fr
authors.forename: Avi
authors.initials: A
authors.lastname: Assouline
authors.forename: Antonin
authors.initials: A
authors.lastname: Levy
authors.forename: Cyrus
authors.initials: C
authors.lastname: Chargari
authors.forename: Ioannis
authors.initials: I
authors.lastname: Lamproglou
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Mazeron
authors.forename: Claude
authors.initials: C
authors.lastname: Krzisch
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000532:radiotherapy* / Q000556:secondary*; D001943:Breast Neoplasms / Q000473:pathology; D016371:Cranial Irradiation / Q000379:methods*; D019583:Dose Fractionation, Radiation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D008545:Melanoma / Q000473:pathology; D008875:Middle Aged; D010315:Particle Accelerators; D011379:Prognosis; D016016:Proportional Hazards Models; D011879:Radiotherapy Dosage; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome