Details
Category: Volume 06 Issue 03 March 2018
Hits: 1273

Title: A Comparative Study of two Fractionations Schedule of Palliative Radiation Therapy in Metastatic Brain Tumour

Authors: Dr Manju Lata Yadav, Dr Shankar L Jakhar, Dr Neeti Sharma, Dr Kunal Jain, Dr H. S Kumar

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i3.93

Abstract

Background: Management of Brain Metastases is a significant health care problem and is most common intracranial malignancy in adults. Whole brain radiotherapy (WBRT) is a mainstay of treatment.  However, there is need to develop fractionation schedules, but total dose still remains dilemma. This prospective study aims to determine treatment outcome and prognostic factors by making comparison of long-course and short-course WBRT schedules.

Materials and Methods: Sixty patients presented with symptomatic brain metastases previously untreated with WBRT were randomized in two arms containing 30 patients. Arm A treated with 30 Gy, 3 Gy/fraction (fr.), 10 fr. and arm B 20 Gy, 4 Gy /fr. (5fr.). All patients were assessed during WBRT and after completion of WBRT.

Results: At 6 month of completion of WBRT objective response rate complete and partial (CR+PR) was 36.6% in arm A and 40% in arm B (p=0.72). WBRT regimen was not associated with survival (p=0.79). On multivariate analysis, age ≤ 65 years (p < 0.05), Karnofsky performance score (KPS) ≥ 70 (vs <70, p < 0.01), no extra-cranial metastases (p < 0.01) were significantly associated with improved survival.

Conclusions: This study suggests that two fractionation schedules showed comparable results. Therefore, short-course WBRT may be used as an effective option in favor of small treatment time and convenient for patients.

Keywords: Brain metastases, Whole Brain Radiotherapy, Fractionation schedules.

References

  1. Tabouret B, Chinot O, Metellus P, Tallet A, Viens P, Goncalves A. Recent trends in Epidemiology of brain metastases: An Overview. Anticancer Res. 2012 Nov; 32(11): 4655-62.
  2. Davis PC, Hudgins PA, Peterman SB et al. Diagnosis of cerebral metastases: double-dose delayed CT vs. contrast-enhanced MR imaging. AJNR Am J Neuroradiol 1991;12: 293-300.
  3. Schouten LJ, Rutten J, Huveneers HA, et al. Incidence of brain metastases in a cohort of patients with carcinoma of breast, colon, kidney, lung and melanoma. Cancer 2002; 94:2698-2705.
  4. Posner JB. Brain metastases: 1995. A brief review J Neurooncol 1996;27:287-293.
  5. Schellinger PD, Meinck HM. Thron A. Diagnostic accuracy of MRI compared to CCT in patients with brain metastases. J Neurooncol 1994;44:275-281.
  6. Hwang TL, Close TP, Grego JM et al. Predilection of brain metastases in grey and white matter junction abd vascular border zones. Cancer 1996:77:1551-1555.
  7. Chao JH, Phillips R, Nickson JJ. Roentgen-ray therapy of cerebral metastases. Cancer 1954; 7:682-689.
  8. Gasper L, Scott C, Rotman M, et al. Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trial. Inf. J Radiant Oncol Biol Phys. 1997;37;745-51.
  9. Joiner MC, Vander Kogel AJ.The Linear-Quadratic approach to fractionation and calculation of isoeffect relationship. In: Steel GG. ed. Basic Clinical Radiobiology .New York: Oxford: 1997:106-112. 
  10. Harwood AR, Simson WJ.Radiation Therapy of cerebral metastases: a randomized prospective clinical trial. Int. J Radiant Oncol Biol Phys. 1977;2: 1091-1094.
  11. Priestman TJ, Dunn J, Brada M, Rampling R,Baker PG. Final results of Royal College of Radiologists trial comparing two different radiotherapy schedules in the treatment of cerebral metastases. Clin Oncol. 1996: 8; 308-315.
  12. Chatani M, Matayoshi Y, Masaki N, Inoue T. Radiation therapy for brain metastases from lung carcinoma. Prospective randomized trial according to the level of lactate dehydrogenase. Strahlenther Oncol. 1994:170:155-161.
  13. Patil CG, Pricola K, Sarmiento JM, Garg SK, Bryant A, Black KL. Whole brain radiotherapy(WBRT) alone versus WBRT and radiosurgrey for the treatment of brain metastases. Cochrane Database Syst Rev. 2017 Sept. 25;9 CD006121. Doi;10.1002/14651858.CD006121. pub4
  14. Tsao MN, Nancy S, Lloyd, Rebecca K.S. Wong, Eileen Rakovitch, Edward Chow, Normand Laperriere; Supportive Care Guidelines Group of Cancer Care Ontario’s Program in Evidence-based Care. Cancer Treat Rev.2005 Jun: 31(4):256-73.
  15. Lagerwaard FJ, Levendag PC. Prognostic factors in patients with brain metastases. Forum (Genova) 2001;11;27-46.

Corresponding Author

Dr Shankar Lal Jakhar

Associate Professor Dept. of Radiation Oncology,

Acharya Tulsi Regional Cancer Treatment & Research Institute, Bikaner

S P Medical College, Bikaner (Rajasthan) India

Mobile no. 09414451043, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.