Comparison of whole brain irradiation 20 Gy versus 30 Gy for the treatment of brain metastases
Keywords:
brain metastases, whole brain irradiation, 20 Gy versus 30 GyAbstract
Problem/Background : Currently, the standard palliative treatment for multiple brain metastases consists of whole brain radiation therapy (WBRT). The WBRT with 30 Gy in 2 weeks is the most commonly used regimen worldwide and can be considered the “standard” schedule. However, the optimal dose-fractionation schedule of WBRT is still controversial. Objective : This retrospective study compares whole brain irradiation with the dose of 20 Gy versus 30 Gy for the treatment of brain metastases. Research design : A retrospective analytical study. Setting : Buddhachinaraj Phitsanulok Hospital Material and Methods : A retrospective study was performed on the records of 118 patients with brain metastases, retrieved from the database of the Radiotherapy Unit, Buddhachinaraj Phitsanulok Hospital. Twenty-eight patients treated with WBRT of 4Gy to a total dose of 20Gy (4Gyx5Fx) were compared to 90 patients treated with 3Gy to a total dose of 30 Gy (3Gyx10Fx) in terms of overall survival (OS). The potential factors affecting survival included age, sex, Karnofsky performance status (KPS), hospital status, Radiation recursive partitioning analysis (RPA) classifi cation, Machine and primary tumor. Survival analyses were performed by Kaplan-Meier method. The Cox proportional Hazard Model was used to assess the association between independent variables and survival. Results : One-year OS among the patients treated with 4Gyx5Fx and 3Gyx10Fx were 14.39 % and 28.89%, respectively. Compare to the patients treated with 20 Gy WBRT, those who received 30 Gy in 2 weeks showed statistically signifi cant improvement in survival (p=0.034). There were more hospital admission among patients treated with 4Gyx5Fx WBRT than 3Gyx10Fx WBRT (p=0.003). All interested factors were not prognostic for OS (p>0.05). Conclusion : Our data suggested that the standard dose-fractionation WBRT (3Gyx10Fx) for patients with brain metastases appeared more preferable than the short course (4Gyx5Fx), showing the better survival. This treatment would be recommended for these patients.
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