Two radiation regimens and prognostic factors for brain Metastases in nonsmall cell lung cancer patients

BACKGROUND. Nonsmall cell lung cancer (NSCLC) patients with brain metastases usually receive whole-brain radiotherapy (WBRT). Most of these patients Survive for only a few months. A short course of WBRT would be preferable to longer regimens if it could provide similar survival. This retrospective study of NSCLC 6 patients compared longer treatment programs with short-course VBRT with 5 X 4 Gy given during 5 days. METHODS. Data from 404 NSCLC patients treated with WBRT for brain metastases were retrospectively analyzed. The 140 patients who received 5 X 4 Gv given in 5 days were compared for survival with 264 patients who received either 10 X 3 Gy given in 2 weeks or 20 X 2 Gy given in 4 weeks. Seven further potential prognostic factors were investigated for survival including age, sex, Karnofsky performance score (KPS), number of brain metastases, extracranial metastases, a interval from tumor diagnosis to WBRT, and RPA (recursive partitioning analysis) class. RESULTS. The WBRT regimen was not associated with survival (P =.55). On multivariate analysis, age < 60 years (vs >= 60 years, P =.020), KPS >= 70 (vs KPS < 70, P <.001), interval from tumor diagnosis to WBRT > 12 months (vs <= 12 months, P =.007), no extracranial metastases (P <.001), and RPA class I (vs RPA class 2 vs RPA class 3, P =.007) were significantly associated with improved survival. CONCLUSIONS. Short-course WBRT with 5 X 4 Gy appeared preferable for most NSCLC patients, as it was associated with survival similar to longer WBRT programs, and the short course was less time consuming. Cancer 2007;110:1077-82. (c) 2007 American Cancer Society.