Outcomes From Whole-Brain Reirradiation Using Pulsed Reduced Dose Rate Radiation Therapy

Adam R. Burr, Henry Ian Robins, Robert Adam Bayliss, Andrew M. Baschnagel, James S. Welsh, Wolfgang A. Tomé, Steven P. Howard

Research output: Contribution to journalArticle

Abstract

Purpose: Recurrent intracranial metastases after whole-brain irradiation pose a clinical challenge owing to the escalating morbidity associated with their treatment. Although stereotactic radiosurgery is increasingly being used, there are still situations in which whole-brain reirradiation (ReRT) continues to be appropriate. Here, we report our experience using whole-brain pulsed reduced dose rate radiation therapy (PRDR), a method that delivers radiation at a slower rate of 0.067 Gy/min to potentially increase sublethal damage repair and decrease toxicity. Methods and Materials: Patients undergoing whole-brain ReRT with PRDR from January 1, 2001 to March 2019 were analyzed. The median PRDR ReRT dose was 26 Gy in 2 Gy fractions, resulting in a median total whole-brain dose of 59.5 Gy. Cox regression analysis was used for multivariate analysis. The Kaplan-Meier method was used for overall survival, progression free survival, and to evaluate the ReRT score. Binary logistic regression was employed to evaluate variables associated with rapid death. Results: Seventy-five patients were treated with whole-brain PRDR radiation therapy. The median age was 54 (range, 26-72), the median Karnofsky performance status (KPS) was 80, and 86.7% had recursive partitioning analysis scores of 2. Thirty-two patients had over 10 metastases and 11 had leptomeningeal disease. The median overall survival was 4.1 months (range, 0.29-59.5 months) with a 1 year overall survival of 10.4%. Age, KPS, dexamethasone usage, and intracranial disease volume were significantly correlated with overall survival on multivariate analysis. A KPS ≤70 was associated with rapid death after radiation. The prognostic value of the ReRT score was validated. The most common acute toxicities were fatigue (23.1%) and headache (16.9%). Conclusions: In this large cohort of patients with advanced intracranial metastases, PRDR achieves acceptable survival and may decrease toxicity associated with ReRT. PRDR is an easily implemented technique and is a viable treatment option for ReRT of brain metastases.

Original languageEnglish (US)
JournalAdvances in Radiation Oncology
DOIs
StateAccepted/In press - 2020

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

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    Burr, A. R., Robins, H. I., Bayliss, R. A., Baschnagel, A. M., Welsh, J. S., Tomé, W. A., & Howard, S. P. (Accepted/In press). Outcomes From Whole-Brain Reirradiation Using Pulsed Reduced Dose Rate Radiation Therapy. Advances in Radiation Oncology. https://doi.org/10.1016/j.adro.2020.06.021