Results of hypofractionated whole brain radiotherapy (2x8 Gy) for patients with brain metastases from lung cancer

Purpose: To evaluate the clinical and radiologic response rates, toxicity and tolerability of 2x8 Gy whole brain radiotherapy (WBRT) in lung cancer patients with brain metastases (BM). Methods: WBRT was delivered to 126 lung cancer patients with BM during 2002-2006. External beam RT was delivered with a fraction dose of 8 Gy on the same day of each consecutive week Tumor and symptom response and toxicity were recorded at every follow-up. Recursive partitioning analysis (RPA) and the new Graded Prognostic Assessment (GPA) were used for analysis of overall survival (OS). Results: Twenty-three patients had small cell (SCLC) and 103 had non small cell lung cancer Pretreatment median Karnofsky performance score (KPS) was 70 (range 20-90). Clinical response rates were as follows: complete 31%; good partial 30.2%; partial 21.4%; stable 7.9%; and progressive 5.6%. Median palliation and survival duration was 57 and 80 days, respectively. Two- and 6-month survival rates (SR) were 59.5% and 25.4%, respectively. According to recursive partitioning analysis (RPA) 6-month SR for groups 1, 2 and 3 were 61.5, 41.6 and 33.9%, respectively (p=0.002). Six-month SR for the new Graded Prognostic Assessment (GPA) were: GPA 0-1, 7%; GPA 1.5-2.5, 34.2%; GPA 3, 25%; and GPA 3.5-4.0, 66.6% (p=0.0003). Conclusion: 2x8 Gy WBRT was found to be feasible. However the late morbidity of this schedule is unknown so its use could be restricted to patients with poor performance status, with a short life expectancy and/or social problems, unlikely to tolerate more protracted radiotherapy regimens.