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Title: High-dose fractionated radiation therapy for select patients with brain metastases

Abstract

Four patients with metastases to the brain were treated by high-dose fractionated radiation therapy. In all four cases, a complete response and prolonged disease-free survival could be documented. Unlike the standard therapy for such patients (i.e., craniotomy and postoperative irradiation), high-dose fractionated radiation therapy carries no operative risk and can encompass multiple brain metastases and metastases in deep or critical intracranial sites. The risk of radiotherapy side effects in the brain is discussed.

Authors:
 [1]; ; ; ;
  1. (City of Hope National Medical Center, Duarte, CA)
Publication Date:
OSTI Identifier:
6297643
Resource Type:
Journal Article
Resource Relation:
Journal Name: Radiology; (United States); Journal Volume: 140:2
Country of Publication:
United States
Language:
English
Subject:
63 RADIATION, THERMAL, AND OTHER ENVIRON. POLLUTANT EFFECTS ON LIVING ORGS. AND BIOL. MAT.; 62 RADIOLOGY AND NUCLEAR MEDICINE; BRAIN; DELAYED RADIATION EFFECTS; NECROSIS; RADIOINDUCTION; NERVOUS SYSTEM DISEASES; RADIOTHERAPY; EVALUATION; SIDE EFFECTS; DOSE RATES; FRACTIONATED IRRADIATION; LOCAL IRRADIATION; METASTASES; PATIENTS; RISK ASSESSMENT; BIOLOGICAL EFFECTS; BIOLOGICAL RADIATION EFFECTS; BODY; CENTRAL NERVOUS SYSTEM; DISEASES; IRRADIATION; MEDICINE; NERVOUS SYSTEM; NUCLEAR MEDICINE; ORGANS; PATHOLOGICAL CHANGES; RADIATION EFFECTS; RADIOLOGY; THERAPY; 560151* - Radiation Effects on Animals- Man; 550603 - Medicine- External Radiation in Therapy- (1980-)

Citation Formats

Pezner, R.D., Lipsett, J.A., Archambeau, J.O., Fine, R.M., and Moss, W.T.. High-dose fractionated radiation therapy for select patients with brain metastases. United States: N. p., 1981. Web. doi:10.1148/radiology.140.2.6789372.
Pezner, R.D., Lipsett, J.A., Archambeau, J.O., Fine, R.M., & Moss, W.T.. High-dose fractionated radiation therapy for select patients with brain metastases. United States. doi:10.1148/radiology.140.2.6789372.
Pezner, R.D., Lipsett, J.A., Archambeau, J.O., Fine, R.M., and Moss, W.T.. 1981. "High-dose fractionated radiation therapy for select patients with brain metastases". United States. doi:10.1148/radiology.140.2.6789372.
@article{osti_6297643,
title = {High-dose fractionated radiation therapy for select patients with brain metastases},
author = {Pezner, R.D. and Lipsett, J.A. and Archambeau, J.O. and Fine, R.M. and Moss, W.T.},
abstractNote = {Four patients with metastases to the brain were treated by high-dose fractionated radiation therapy. In all four cases, a complete response and prolonged disease-free survival could be documented. Unlike the standard therapy for such patients (i.e., craniotomy and postoperative irradiation), high-dose fractionated radiation therapy carries no operative risk and can encompass multiple brain metastases and metastases in deep or critical intracranial sites. The risk of radiotherapy side effects in the brain is discussed.},
doi = {10.1148/radiology.140.2.6789372},
journal = {Radiology; (United States)},
number = ,
volume = 140:2,
place = {United States},
year = 1981,
month = 8
}
  • Purpose: To determine if high-dose melatonin for Radiation Therapy Oncology Group (RTOG) recursive partitioning analysis (RPA) Class 2 patients with brain metastases improved survival over historical controls, and to determine if the time of day melatonin was given affected its toxicity or efficacy. RTOG 0119 was a phase II randomized trial for this group of patients. Methods and Materials: RTOG RPA Class 2 patients with brain metastases were randomized to 20 mg of melatonin, given either in the morning (8-9 AM) or in the evening (8-9 PM). All patients received radiation therapy (30 Gy in 10 fractions) in the afternoon.more » Melatonin was continued until neurologic deterioration or death. The primary endpoint was overall survival time. Neurologic deterioration, as reflected by the Mini-Mental Status Examination, was also measured. Results: Neither of the randomized groups had survival distributions that differed significantly from the historic controls of patients treated with whole-brain radiotherapy. The median survivals of the morning and evening melatonin treatments were 3.4 and 2.8 months, while the RTOG historical control survival was 4.1 months. Conclusions: High-dose melatonin did not show any beneficial effect in this group of patients.« less
  • Purpose: To create and validate scoring systems for intracerebral control (IC) and overall survival (OS) of patients irradiated for brain metastases. Methods and Materials: In this study, 1,797 patients were randomly assigned to the test (n = 1,198) or the validation group (n = 599). Two scoring systems were developed, one for IC and another for OS. The scores included prognostic factors found significant on multivariate analyses. Age, performance status, extracerebral metastases, interval tumor diagnosis to RT, and number of brain metastases were associated with OS. Tumor type, performance status, interval, and number of brain metastases were associated with IC.more » The score for each factor was determined by dividing the 6-month IC or OS rate (given in percent) by 10. The total score represented the sum of the scores for each factor. The score groups of the test group were compared with the corresponding score groups of the validation group. Results: In the test group, 6-month IC rates were 17% for 14-18 points, 49% for 19-23 points, and 77% for 24-27 points (p < 0.0001). IC rates in the validation group were 19%, 52%, and 77%, respectively (p < 0.0001). In the test group, 6-month OS rates were 9% for 15-19 points, 41% for 20-25 points, and 78% for 26-30 points (p < 0.0001). OS rates in the validation group were 7%, 39%, and 79%, respectively (p < 0.0001). Conclusions: Patients irradiated for brain metastases can be given scores to estimate OS and IC. IC and OS rates of the validation group were similar to the test group demonstrating the validity and reproducibility of both scores.« less
  • Between January, 1971, and February 1976, the Radiation Therapy Oncology Group entered 1902 evaluable patients into two sequential Phase III national cooperative trials to study the effectiveness of different time dose radiotherapy schemes on the palliation of patients with brain metastases. Each trial included an optional arm into which patients were randomized to receive 1000 rad/1 fraction (26 patients, first study) or 1200 rad/2 fractions (33 patients, second study). Comparisons were made with 143 control patients randomized by the same participating institutions to receive a more protracted course of irradiation (2000, 3000 or 4000 rad/1-4 wks). Response of patients receivingmore » ultra-rapid treatment, as assessed by the percent who had improvement in neurologic function, was comparable to that of patients receiving the more protracted schedules. Promptness of neurologic function improvement, treatment morbidity and median survival were also comparable to those of patients receiving 2000 to 4000 rad. However, the duration of improvement, time to progression of neurologic status and rate of complete disappearance of neurologic symptoms were generally less for those patients who received 1000 or 1200 rad. These results suggest that ultra-rapid, high dose irradiation schedules may not be so effective as higher dose schedules in the palliation of patients with brain metastases.« less
  • Between January, 1971, and February, 1976, the Radiation Therapy Oncology Group entered 1902 evaluable patients into two sequential Phase III national cooperative trials to study the effectiveness of different time dose radiotherapy schemes on the palliation of patients with brain metastases. Each trial included an optional arm into which patients were randomized to receive 1000 rad/1 fraction (26 patients, First study) or 1200 rad/2 fractions (33 patients, Second study). Comparisons were made with 143 control patients randomized by the same participating institutions to receive a more protracted course of irradiation (2000, 3000 or 4000 rad/1-4wks). Response of patients receiving ultra-rapidmore » treatment, as assessed by the percent who had improvement in neurologic function, was comparable to that of patients receiving the more protracted schedules. Promptness of neurologic function improvement, treatment morbidity and median survival were also comparable to those of patients receiving 2000 to 4000 rad. However, the duration of improvement, time to progression of neurologic status and rate of complete disappearance of neurologic symptoms were generally less for those patients who received 1000 or 1200 rad. These results suggest that ultra-rapid, high dose irradiation schedules may not be so effective as higher dose schedules in the palliation of patients with brain metastases.« less
  • Purpose: Radiation Therapy Oncology Group (RTOG) 0118 randomized patients with multiple brain metastases to whole-brain radiotherapy (WBRT) {+-} thalidomide. This secondary analysis of 156 patients examined neurocognitive and quality of life (QOL) outcomes. Methods and Materials: Quality of life was determined with the Spitzer Quality of Life Index (SQLI). The Folstein Mini-Mental Status Exam (MMSE) assessed neurocognitive function. SQLI and MMSE were administered at baseline and at 2-month intervals. MMSE was scored with a threshold value associated with neurocognitive functioning (absolute cutoff level of 23) and with the use of corrections for age and educational level. Results: Baseline SQLI predictedmore » survival. Patients with SQLI of 7-10 vs. <7 had median survival time (MST) of 4.8 vs. 3.1 months, p = 0.05. Both arms showed steady neurocognitive declines, but SQLI scores remained stable. Higher levels of neurocognitive decline were observed with age and education-level corrections. Of patients considered baseline age/educational level neurocognitive failures, 32% died of intracranial progression. Conclusions: Quality of life and neuropsychological testing can be prospectively administered on a Phase III cooperative group trial. The MMSE should be evaluated with adjustments for age and educational level. Baseline SQLI is predictive of survival. Despite neurocognitive declines, QOL remained stable during treatment and follow-up. Poor neurocognitive function may predict clinical deterioration. Lack of an untreated control arm makes it difficult to determine the contribution of the respective interventions (i.e., WBRT, thalidomide) to neurocognitive decline. The RTOG has developed a trial to study the role of preventative strategies aimed at forestalling neurocognitive decline in this population.« less