The treatment of patients with 1-3 brain metastases: is there a place for whole brain radiotherapy alone, yet? A retrospective analysis

Michela Buglione; Sara Pedretti; Stefano Gipponi; Luciano Buttolo; Paolo Panciani; Pietro Luigi Poliani; Roberto Liserre; Paolo Borghetti; Ludovica Pegurri; Loredana Costa; Luca Triggiani; Nadia Pasinetti; Paolo Ghirardelli; Sara Pandini; Alessandro Padovani; Stefano Maria Magrini; Neuro-Oncology Group, Spedali Civili Hospital and Brescia University

doi:10.1007/s11547-015-0542-0

The treatment of patients with 1-3 brain metastases: is there a place for whole brain radiotherapy alone, yet? A retrospective analysis

Radiol Med. 2015 Dec;120(12):1146-52. doi: 10.1007/s11547-015-0542-0. Epub 2015 Apr 28.

Authors

Michela Buglione¹, Sara Pedretti², Stefano Gipponi³, Luciano Buttolo⁴, Paolo Panciani⁴, Pietro Luigi Poliani⁵, Roberto Liserre⁶, Paolo Borghetti², Ludovica Pegurri², Loredana Costa², Luca Triggiani², Nadia Pasinetti², Paolo Ghirardelli², Sara Pandini², Alessandro Padovani³, Stefano Maria Magrini²; Neuro-Oncology Group, Spedali Civili Hospital and Brescia University

Affiliations

¹ Radiation Oncology Department, Spedali Civili Hospital, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy. michela.buglione@unibs.it.
² Radiation Oncology Department, Spedali Civili Hospital, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy.
³ Neurology Department, Spedali Civili Hospital, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy.
⁴ Neurosurgery Department, Spedali Civili Hospital, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy.
⁵ Pathology Department, Spedali Civili Hospital, Brescia University, P.le Spedali Civili 1, 25123, Brescia, Italy.
⁶ Neuroradiology Department, Spedali Civili Hospital Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.

PMID: 25917339
DOI: 10.1007/s11547-015-0542-0

Abstract

Aim: To evaluate the efficacy of whole brain radiotherapy (WBRT) with or without other treatments in patients (pts) with 1-3 brain metastases (BM).

Materials and 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.

Keywords: Brain metastases; Prognostic factors; Radiotherapy; Stereotactic radiotherapy; Surgery; Survival.

MeSH terms

Brain Neoplasms / mortality
Brain Neoplasms / radiotherapy*
Brain Neoplasms / secondary*
Humans
Multivariate Analysis
Retrospective Studies