Radiotherapy of brain metastases from lung cancer

Purpose: The data of 132 patients who were treated between 1983 and 1992 because of cerebral metastases from lung cancer were retrospectively analysed, in order to find criteria for patients selection to radiotherapy with simultaneous application of corticosteroids. Methods: Radiotherapy was given either in 10 fractions of 3 Gy over 2 weeks (97 patients) or in 20 fractions of 2 Gy over 4 weeks (35 patients), always in form of a whole-brain irradiation. Before and during radiotherapy dexamethasone was administered. Results: The local remission rate was 56% for both treatment schedules. In cases with a complete remission median survival was significantly longer compared with partial remission or no change. The median survival of the whole group was 4 months. Patients with extracerebral metastases and a Karnofsky-score <7 or brain metastases ≥2,5 cm had a median survival of only 2 months, whereas patients with only brain metastases and a Karnofsky-score ≥7 or brain metastases <2,5 cm had a median survival of 6 months. 11% of the patients were asymptomatic. A symptomatic relief, additional to the effect of corticosteroid therapy, was found in 43% of cases, which was dependent on local remission and tendencially on dose of corticosteroids. In a multivariate analysis performance status, extracerebral metastases, and size of cerebral metastases were found to be prognostic parameters. Conclusion: Radiotherapy with 10x3 Gy seems to be appropriate for the majority of patients, when expense and hospitalisation time are compared with results and benefit. Selected patients may profite from a more aggressive treatment approach. In some cases radiotherapy may be an unsuitable overtreatment. (orig.)