Simultaneous radiotherapy and chemotherapy in the treatment of brain metastases of malignant solid tumours.

Between January 1982 and June 1985, 105 patients with brain metastases of malignant solid tumours were treated in the Robert Janker Clinic. In order to optimize the overall response rates, concomitant radiotherapy and cytostatic chemotherapy was used. In most cases the primary tumour was located in the breast or the lung. Radiotherapy was performed with a Cobalt 60 equipment. The whole brain was irradiated in daily fractions of 15 Gy up to total dose of 45 Gy. Using a slit-course technique this dose was distributed to the three cycles of chemotherapy and given simultaneously, i.e. 15 Gy/ by course. The chemotherapeutic regimen consisted of ifosfamide daily for five days at 2g/m2 and the nitrosurea derivative carmustin (BCNU) at 30 mg/m2 on days 1, 3 and 5. After a free interval of four to five weeks the concomitant radiotherapy and chemotherapy was repeated twice. The tolerance of the treatment was generally good; no severe haematological or gastrointestinal complications occurred. There was a complete and permanent alopecia in all patients caused by the radiation. All patients received a cranial computerized axial tomographic scan prior to and after the treatment. According to the criteria of the International Union Against Cancer, there was a complete remission in 26 of the 105 patients and a partial remission in 49; 19 patients showed a stable disease. Only 12 of the 105 treated patients had a progression of their metastases. Only patients with partial or complete remissions after the treatment belong to the "long-term" survivors.