title: Effect of chemotherapy on survival after whole brain radiation therapy for brain metastases: a single-center retrospective analysis.
abstract: OBJECTIVE
  Whether chemotherapy for systemic disease affects survival of patients with brain metastases or not has not been elucidated before. We performed comprehensive analysis of patients with newly-diagnosed brain metastases primarily treated with whole brain radiation therapy (WBRT) alone.
  
  
  METHODS
  Data from 134 patients with newly-diagnosed brain metastases primarily treated with WBRT from 2007 to 2008 was retrospectively reviewed. Univariate and multivariate analyses were performed to identify significant prognostic factors.
  
  
  RESULTS
  Median survival time (MST) of this cohort from the start of WBRT was 5.7 months. MST of patients with RPA Class 1, 2 and 3 were 10.3, 7.8 and 2.2 months, respectively. Multivariate analysis revealed that karnofsky performance status (≥ 70, p < 0.0001), gender (female, p < 0.0001), activity of extracranial disease (stable, p = 0.015), time to develop brain metastasis (<3 months, p = 0.042) and use of chemotherapy after WBRT (multiple regimens, p < 0.0001) were independent prognostic factors for better survival.
  
  
  CONCLUSIONS
  Systemic chemotherapy for chemo-responsive cancer prolongs survival despite the presence of treated brain metastases. Irradiated brain metastases will lose their prognostic significance in a large number of patients. Systemic chemotherapy will be a treatment of choice for patients who have systemic disease after WBRT for brain metastases. These results should be validated in the future prospective clinical trials.
authors.affiliation: Division of Radiation Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan. hmayahar@ncc.go.jp
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Mayahara
authors.forename: Minako
authors.initials: M
authors.lastname: Sumi
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Ito
authors.forename: Syuhei
authors.initials: S
authors.lastname: Sekii
authors.forename: Kana
authors.initials: K
authors.lastname: Takahashi
authors.forename: Kouji
authors.initials: K
authors.lastname: Inaba
authors.forename: Yuuki
authors.initials: Y
authors.lastname: Kuroda
authors.forename: Naoya
authors.initials: N
authors.lastname: Murakami
authors.forename: Madoka
authors.initials: M
authors.lastname: Morota
authors.forename: Jun
authors.initials: J
authors.lastname: Itami
mesh_terms: D000368:Aged; D001921:Brain / Q000187:drug effects* / Q000473:pathology / Q000528:radiation effects*; D001932:Brain Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome