BACKGROUND: The majority of breast cancer patients with brain metastases receive whole-brain radiotherapy (WBRT) and have a survival of only a few months. A short WBRT regimen would be preferable if it provides survival that is similar to that achieved with longer programs. This retrospective study compared survival and local control within the brain resulting from short-course WBRT with longer programs in 207 breast cancer patients. METHODS: Sixty-nine patients treated with 5 fractions of 4 grays (Gy) each given within 5 days were compared with 138 patients treated with 10 fractions of 3 Gy each given over 2 weeks or 20 fractions of 2 Gy each given over 4 weeks. Six additional potential prognostic factors were investigated: age, Karnofsky performance score (KPS), number of brain metastases, the presence of extracranial metastases, interval from tumor diagnosis to WBRT, and recursive partitioning analysis (RPA) class. RESULTS: On univariate analysis, the WBRT regimen was not found to be associated with survival (P=.254) or local control (P=.397). Improved survival was associated with a KPS>70 (P<.001), single brain metastasis (P=.023), the absence of extracranial metastases (P<.001), and lower RPA class (P<.001). On multivariate analysis, which was performed without RPA class because this is a confounding variable, KPS (relative risk [RR] of 4.00; P<.001) and the presence of extracranial metastases (RR of 1.54; P=.024) maintained statistical significance. On univariate analysis, local control was associated with KPS (P<.001) and RPA class (P<.001). On multivariate analysis, local control was found to be associated with a KPS>70 (RR of 5.75; P<.001). CONCLUSIONS: Short-course WBRT with 5 fractions of 4 Gy each resulted in survival and local control that were similar to longer programs in breast cancer patients with brain metastases. The dose of 5 fractions of 4 Gy each appears preferable for the majority of these patients because it is less time consuming and more convenient. Copyright (c) 2007 American Cancer Society.
BACKGROUND: The majority of breast cancerpatients with brain metastases receive whole-brain radiotherapy (WBRT) and have a survival of only a few months. A short WBRT regimen would be preferable if it provides survival that is similar to that achieved with longer programs. This retrospective study compared survival and local control within the brain resulting from short-course WBRT with longer programs in 207 breast cancerpatients. METHODS: Sixty-nine patients treated with 5 fractions of 4 grays (Gy) each given within 5 days were compared with 138 patients treated with 10 fractions of 3 Gy each given over 2 weeks or 20 fractions of 2 Gy each given over 4 weeks. Six additional potential prognostic factors were investigated: age, Karnofsky performance score (KPS), number of brain metastases, the presence of extracranial metastases, interval from tumor diagnosis to WBRT, and recursive partitioning analysis (RPA) class. RESULTS: On univariate analysis, the WBRT regimen was not found to be associated with survival (P=.254) or local control (P=.397). Improved survival was associated with a KPS>70 (P<.001), single brain metastasis (P=.023), the absence of extracranial metastases (P<.001), and lower RPA class (P<.001). On multivariate analysis, which was performed without RPA class because this is a confounding variable, KPS (relative risk [RR] of 4.00; P<.001) and the presence of extracranial metastases (RR of 1.54; P=.024) maintained statistical significance. On univariate analysis, local control was associated with KPS (P<.001) and RPA class (P<.001). On multivariate analysis, local control was found to be associated with a KPS>70 (RR of 5.75; P<.001). CONCLUSIONS: Short-course WBRT with 5 fractions of 4 Gy each resulted in survival and local control that were similar to longer programs in breast cancerpatients with brain metastases. The dose of 5 fractions of 4 Gy each appears preferable for the majority of these patients because it is less time consuming and more convenient. Copyright (c) 2007 American Cancer Society.
Authors: Paul W Sperduto; Norbert Kased; David Roberge; Zhiyuan Xu; Ryan Shanley; Xianghua Luo; Penny K Sneed; Samuel T Chao; Robert J Weil; John Suh; Amit Bhatt; Ashley W Jensen; Paul D Brown; Helen A Shih; John Kirkpatrick; Laurie E Gaspar; John B Fiveash; Veronica Chiang; Jonathan P S Knisely; Christina Maria Sperduto; Nancy Lin; Minesh Mehta Journal: Int J Radiat Oncol Biol Phys Date: 2011-04-15 Impact factor: 7.038
Authors: B Ashleigh Guadagnolo; Kai-Ping Liao; Linda Elting; Sharon Giordano; Thomas A Buchholz; Ya-Chen Tina Shih Journal: J Clin Oncol Date: 2012-11-19 Impact factor: 44.544
Authors: Laurie E Gaspar; Minesh P Mehta; Roy A Patchell; Stuart H Burri; Paula D Robinson; Rachel E Morris; Mario Ammirati; David W Andrews; Anthony L Asher; Charles S Cobbs; Douglas Kondziolka; Mark E Linskey; Jay S Loeffler; Michael McDermott; Tom Mikkelsen; Jeffrey J Olson; Nina A Paleologos; Timothy C Ryken; Steven N Kalkanis Journal: J Neurooncol Date: 2009-12-04 Impact factor: 4.130