title: 3D radiation therapy boost improves the outcome of whole brain radiation therapy treated RPA II patients with one or two brain metastases.
abstract: OBJECTIVE
  to evaluate the role of whole brain radiotherapy (WBRT) and radiation boost (RB) for 208 patients recursive partitioning analysis (RPA) II with 1 or 2 brain metastases (BM) at a single institution.
  
  
  METHODS
  the dose of WBRT was 30 Gy (10 fractions of 3 Gy). One hundred thirty-two patients (63.5%) benefited from RB of 9 Gy in 3 fractions of 3 Gy at the metastatic site. Patients had 1 or 2 BM in 122 (58.7%) and 86 cases (41.3%), respectively.
  
  
  RESULTS
  patients with one or two metastases had similar survival (4.6 and 5.1 months, respectively) (p = 0.4). Median overall survival (OS) for patients treated with WBRT and RB, and with WBRT alone was 5.9 and 3.7 months, respectively (p = 0.03). The 6-, 12- and 24-month OS rates after WBRT and RB were 48.5%, 25% and 10.6%, respectively, while WBRT alone resulted in OS rates of 34%, 22.4% and 3.2%, respectively (p = 0.03). After WBRT and RB, the 6-, 12- and 24-month local control rates were 92%, 82% and 67%, respectively, while they were 81.2%, 75% and 37.5%, respectively, after WBRT alone (p = 0.03). The 6-, 12- and 24-month brain control rates after WBRT and RB were 88.7%, 75.8% and 62%, respectively, and after WBRT alone they were 78.5%, 59% and 37.7%, respectively (p = 0.03).
  
  
  CONCLUSIONS
  additional boost delivered with 3D conformal radiotherapy improves local and brain control rates significantly as well as overall survival for RPA II patients with 1 or 2 unresectable BM.
authors.affiliation: Radiotherapy Department, Centre de Lutte Contre le Cancer Paul Strauss, 3, rue de la Porte de L'Hôpital, 67065 Strasbourg Cedex, France. DAntoni@strasbourg.unicancer.fr.
authors.forename: Delphine
authors.initials: D
authors.lastname: Antoni
authors.affiliation: Radiotherapy Department, Centre de Lutte Contre le Cancer Paul Strauss, 3, rue de la Porte de L'Hôpital, 67065 Strasbourg Cedex, France. JClavier@strasbourg.unicancer.fr.
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Clavier
authors.affiliation: Radiotherapy Department, Centre de Lutte Contre le Cancer Paul Strauss, 3, rue de la Porte de L'Hôpital, 67065 Strasbourg Cedex, France. MPop@strasbourg.unicancer.fr.
authors.forename: Marius
authors.initials: M
authors.lastname: Pop
authors.affiliation: Radiotherapy Department, Centre de Lutte Contre le Cancer Paul Strauss, 3, rue de la Porte de L'Hôpital, 67065 Strasbourg Cedex, France. CSchumacher@strasbourg.unicancer.fr.
authors.forename: Catherine
authors.initials: C
authors.lastname: Schumacher
authors.affiliation: Laboratory of Biostatistics, Faculté de Médecine, 4, rue Kirschleger, 67085 Strasbourg Cedex, France. Francois.lefebvre@chru-strasbourg.fr.
authors.forename: François
authors.initials: F
authors.lastname: Lefebvre
authors.affiliation: Radiotherapy Department, Centre de Lutte Contre le Cancer Paul Strauss, 3, rue de la Porte de L'Hôpital, 67065 Strasbourg Cedex, France. GNoel@strasbourg.unicancer.fr.
authors.forename: Georges
authors.initials: G
authors.lastname: Noël
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000473:pathology* / Q000528:radiation effects*; D001932:Brain Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000556:secondary*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult