RADIOTHERAPY FOR BRAIN METASTASES - A CRITICAL ANALYSIS OF DOSE FRACTIONATION AND MORTALITY

Introduction: Brain metastases are the most common type of brain cancer, almost 6 to 10 times more common than the primary tumors. The therapeutic approach has already been established, consisting of surgery, fractionated radiotherapy and radiosurgery. Regarding radiotherapy, dose fractioning for brain metastases does not show statistic differences regarding survival rates, however, they may optimize the treatment compliance and the levels of quality of life. Objective: This study aims to analyze the dose fractionation in radiotherapy for brain metastases at Hospital Erasto Gaetrner (from 2015 to 2018) and compare its relation by pathology and mortality. Method: The medical records of 217 patients submitted to palliative radiotherapy for the Nervous Central System were analyzed (from 2015 to 2018). The patients stratification criteria were their gender, age, dose, and fractionation, compared to their mortality rates and treatment non-compliance. Results: According to literature, the lungs are the most prevalent primary site (32%), followed by breast (32%), melanoma (12%); rectum (5.5%); kidneys (4%) and other unknown primary sites (14%). The average age at metastatic diagnosis was observed in the groups < 65 years (64%), followed by the group >70 years (41%) and 65-70 (16,58%). Concerning the dose and fractionation, there was homogeneity index in two main protocols: 35,5Gy in 15 fractions (47%), 30Gy in 10 fractions (41%) followed by 40Gy in 20 fractions (8%) and others (4%). In terms of gender, there was more incidence in women (61%) than in men (39%) and the predominant technique was the conventional treatment (2D) (84%) versus the conformal (3D) one (15%), also the radiosurgery - SRS (1%). The mortality rate was 42% in patients with primary lung cancer and 10,5% regarding breast cancer. The non-compliance rate to the treatment was 10% and it was caused by worsening in the performance status, with only (1%) of patients refusal. Conclusions: It is known that the traditional cranial irradiation has been being replaced by radiosurgery and stereotactic radiotherapy, however, it still remains as the pattern treatment prescribed. Brain metastases treatment in this service showed high palliative protocols variation, the group that received the lowest number of fractions per treatment and the one with the lowest non-compliance rates; also, there was no difference in mortality rates.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
23 October 2019