Therapeutic trials in the management of metastatic brain tumors by different time/dose fraction schemes of radiation therapy.

Two consecutive studies have been performed by the Radiation Therapy Oncology Group on patients with metastatic brain tumors. Approximately 1,000 patients were entered into each trial. Treatment schedules of varying dose-time fractionations were used. Results were evaluated on the basis of improvement in general performance and neurologic function status. Survival also was recorded. Patients who received corticosteroids in conjunction with radiation therapy experienced a more rapid improvement in neurologic function than patients who did not receive steroid therapy. This was noted particularly in patients with poor neurologic function status. However, by the 4th week this difference had disappeared. Survival times were not altered by the addition of steroid therapy. Preliminary results of the second study suggest that ultra-short fractionation schedules are less effective than the longer ones used in the first study. A dose of 3,000 rads given in 10 equal fractions for a period of 2 weeks appeared to be the most satisfactory schedule for most patients with intracranial metastases.