The treatment of patients with 1-3 brain metastases: is there a place for whole brain radiotherapy alone, yet? A retrospective analysis.
OBJECTIVE
To evaluate the efficacy of whole brain radiotherapy (WBRT) with or without other treatments in patients (pts) with 1-3 brain metastases (BM).


METHODS
Toxicities and survival of 134 pts treated between 2009 and 2013 with WBRT alone (58 pts), WBRT plus surgery (SUR-WBRT: 42 pts) or WBRT followed by stereotactic or integrated boost radiotherapy (SRT-WBRT: 34 pts) were analyzed. Differences in toxicity (acute and late) incidence and in overall (OS), disease-free (DFS) and disease-specific survival (DSS) were evaluated (χ(2)-test, uni- and multivariate analysis).


RESULTS
Pts given intensified treatments (SUR- and SBRT-WBRT) had better 3-month local response compared to WBRT alone group (p < 0.045). Better 1-year local control was evident only in SRT-WBRT pts (p < 0.035). Univariate OS analysis confirmed, as favorable prognostic factors, RPA class I (p < 0.001), GPA class III and IV (p < 0.001), single metastasis (p = 0.045), stable primary disease (p = 0.03), intensified treatment (p = 0.000), systemic therapy after radiotherapy (p = 0.04) and response of metastatic lesions (p = 0.002). At multivariate analysis, OS was better in RPA class I pts (p = 0.002), who had more aggressive radiotherapy treatments (p = 0.001), chemotherapy after radiotherapy (p < 0.001) and response to RT (p = 0.003). Response to radiotherapy (p = 0.002) and BM number (p < 0.001) resulted independently prognostic for DFS. About 60 % of patients had mild acute toxicity (G1), especially headache (51 %) and fatigue (34 %); only 2 patients (2 %) had severe (G3) headache and 5 patients (4 %) severe fatigue (G3) reversible with oral steroids. No differences were evident between the different treatment groups. Among 80 pts followed up with MRI, 12 (15 %) had leukoencephalopathy (equally distributed across subgroups) and 5 (6 %) radionecroses, 4/5 asymptomatic, 5/5 in pts given intensified treatments.


CONCLUSIONS
This analysis confirms the known prognostic factors for BM, emphasizing the importance of intensified treatments in a population with favorable features.
Radiation Oncology Department, Spedali Civili Hospital, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy. michela.buglione@unibs.it.
Michela
M
Buglione
Radiation Oncology Department, Spedali Civili Hospital, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy.
Sara
S
Pedretti
Neurology Department, Spedali Civili Hospital, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy.
Stefano
S
Gipponi
Neurosurgery Department, Spedali Civili Hospital, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy.
Luciano
L
Buttolo
Neurosurgery Department, Spedali Civili Hospital, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy.
Paolo
P
Panciani
Pathology Department, Spedali Civili Hospital, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy.
Pietro Luigi
PL
Poliani
Neuroradiology Department, Spedali Civili Hospital Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
Roberto
R
Liserre
Radiation Oncology Department, Spedali Civili Hospital, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy.
Paolo
P
Borghetti
Radiation Oncology Department, Spedali Civili Hospital, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy.
Ludovica
L
Pegurri
Radiation Oncology Department, Spedali Civili Hospital, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy.
Loredana
L
Costa
Radiation Oncology Department, Spedali Civili Hospital, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy.
Luca
L
Triggiani
Radiation Oncology Department, Spedali Civili Hospital, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy.
Nadia
N
Pasinetti
Radiation Oncology Department, Spedali Civili Hospital, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy.
Paolo
P
Ghirardelli
Radiation Oncology Department, Spedali Civili Hospital, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy.
Sara
S
Pandini
Neurology Department, Spedali Civili Hospital, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy.
Alessandro
A
Padovani
Radiation Oncology Department, Spedali Civili Hospital, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy.
Stefano Maria
SM
Magrini
D001932:Brain Neoplasms / Q000401:mortality / Q000532:radiotherapy* / Q000556:secondary*; D006801:Humans; D015999:Multivariate Analysis; D012189:Retrospective Studies
Brain metastases; Prognostic factors; Radiotherapy; Stereotactic radiotherapy; Surgery; Survival