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Open Access Research article

Prognostic factors for outcomes after whole-brain irradiation of brain metastases from relatively radioresistant tumors: a retrospective analysis

Thekla Meyners1, Christine Heisterkamp1, Jan-Dirk Kueter1, Theo Veninga2, Lukas JA Stalpers3, Steven E Schild4 and Dirk Rades5*

Author affiliations

1 Department of Radiation Oncology, University of Lubeck, Germany

2 Department of Radiation Oncology, Dr. Bernard Verbeeten Institute Tilburg, The Netherlands

3 Department of Radiation Oncology, Academic Medical Center Amsterdam, The Netherlands

4 Department of Radiation Oncology, Mayo Clinic Scottsdale, USA

5 Department of Radiation Oncology, University of Lubeck, Germany and Department of Radiation Oncology, University of Hamburg, Germany

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Citation and License

BMC Cancer 2010, 10:582  doi:10.1186/1471-2407-10-582

Published: 26 October 2010

Abstract

Background

This study investigated potential prognostic factors in patients treated with whole-brain irradiation (WBI) alone for brain metastases from relatively radioresistant tumors such as malignant melanoma, renal cell carcinoma, and colorectal cancer. Additionally, a potential benefit from escalating the radiation dose was investigated.

Methods

Data from 220 patients were retrospectively analyzed for overall survival and local control. Nine potential prognostic factors were evaluated: tumor type, WBI schedule, age, gender, Karnofsky performance score, number of brain metastases, extracerebral metastases, interval from diagnosis of cancer to WBI, and recursive partitioning analysis (RPA) class.

Results

Survival rates at 6 and 12 months were 32% and 19%, respectively. In the multivariate analysis, WBI doses >30 Gy (p = 0.038), KPS ≥70 (p < 0.001), only 1-3 brain metastases (p = 0.007), no extracerebral metastases (p < 0.001), and RPA class 1 (p < 0.001) were associated with improved survival. Local control rates at 6 and 12 months were 37% and 15%, respectively. In the multivariate analyses, KPS ≥70 (p < 0.001), only 1-3 brain metastases (p < 0.001), and RPA class 1 (p < 0.001) were associated with improved local control. In RPA class 3 patients, survival rates at 6 months were 10% (35 of 39 patients) after 10 × 3 Gy and 9% (2 of 23 patients) after greater doses, respectively (p = 0.98).

Conclusions

Improved outcomes were associated with WBI doses >30 Gy, better performance status, fewer brain metastases, lack of extracerebral metastases, and lower RPA class. Patients receiving WBI alone appear to benefit from WBI doses >30 Gy. However, such a benefit is limited to RPA class 1 or 2 patients.