Strahlentherapie und Onkologie

, Volume 186, Issue 2, pp 70–75

Dose Escalation in Patients Receiving Whole-Brain Radiotherapy for Brain Metastases from Colorectal Cancer

  • Christine Heisterkamp
  • Tiina Haatanen
  • Steven E. Schild
  • Dirk Rades
Original Article

Background and Purpose:

Whole-brain radiotherapy (WBRT) alone is the most common treatment for brain metastases from colorectal cancer, as most patients are not candidates for more aggressive therapies such as resection or radiosurgery. The standard WBRT regimen, 30 Gy in ten fractions (10 × 3 Gy), has generally resulted in poor outcomes. This study investigated whether an escalation of the WBRT dose improves these results.

Patients and Methods:

Data from 53 patients receiving WBRT alone for brain metastases from colorectal cancer were retrospectively analyzed. 10 × 3 Gy (n = 35) was compared to higher doses (40 Gy/20 fractions or 45 Gy/15 fractions; n = 18) for overall survival (OS) and local control (LC). Additional factors evaluated for prognostic importance included age, gender, performance status, number of metastases, and extracerebral metastases.

Results:

The OS rates at 6 months were 17% after 10 × 3 Gy and 50% after 20 × 2 Gy/15 × 3 Gy (p = 0.014). On multivariate analysis, improved OS was significantly associated with higher WBRT dose (p = 0.047), Karnofsky Performance Score (KPS) ≥ 70 (p = 0.034), less than four brain metastases (p = 0.036), and lack of extracerebral metastases (p = 0.010). The LC rates at 6 months were 17% after 10 × 3 Gy and 50% after higher doses (p = 0.018). On multivariate analysis of LC, higher WBRT dose was significant (p = 0.028). A trend was observed for KPS ≥ 70 (p = 0.08) and less than four brain metastases (p = 0.06).

Conclusion:

These data suggest that patients with brain metastases from colorectal cancer treated with WBRT alone appeared to benefit from escalation of the radiation dose beyond 10 × 3 Gy in terms of improved OS and LC.

Key Words:

Colorectal cancer Brain metastases Dose escalation Overall survival Local control 

Dosiseskalation bei der Ganzhirnbestrahlung von Hirnmetastasen eines kolorektalen Karzinoms

Hintergrund und Ziel:

Die alleinige Ganzhirnbestrahlung (WBRT) ist die häufigste Therapieform bei der Behandlung von Hirnmetastasen eines kolorektalen Karzinoms. Die meisten dieser Patienten sind für eine aggressivere Therapie (Operation, Radiochirurgie) nicht geeignet. Die Behandlungsergebnisse nach einer WBRT mit dem Standardschema 10 × 3 Gy sind unbefriedigend. Diese Studie untersucht, ob eine Dosiseskalation zu einer Verbesserung der Ergebnisse führt.

Patienten und Methodik:

Daten von 53 Patienten, die eine alleinige WBRT bei Metastasen eines kolorektalen Karzinoms erhalten hatten, wurden retrospektiv ausgewertet (Tabelle 1). 10 × 3 Gy (n = 35) wurde mit höheren Dosen was (20 × 2 Gy oder 15 × 3 Gy; n = 18) für das Gesamtüberleben (OS) und die lokale Kontrolle (LC) verglichen. Zusätzlich wurden folgende mögliche Prognosefaktoren untersucht: Alter, Geschlecht, Allgemeinzustand, Anzahl der Hirnmetastasen sowie Vorliegen extrazerebraler Metastasen.

Ergebnisse:

Die Raten für das OS nach 6 Monaten betrugen 17% nach 10 × 3 Gy und 50% nach 20 × 2 Gy/15 × 3 Gy (p = 0,014; Tabelle 2, Abbildung 1). In der Multivarianzanalyse war ein besseres OS signifikant mit höherer Dosis (p = 0,047), besserem Allgemeinzustand (p = 0,034), Vorliegen von weniger als vier Hirnmetastasen (p = 0,036) und Nichtvorliegen extrazerebraler Metastasen (p = 0,010) assoziiert. Die Raten für die LC nach 6 Monaten betrugen 17% nach 10 × 3 Gy und 50% nach höheren Dosen (p = 0,018; Tabelle 3, Abbildung 2). In der Multivarianzanalyse war eine bessere LC signifikant mit höherer Dosis (p = 0,028) assoziiert. Ein Trend zeigte sich für einen besseren Allgemeinzustand (p = 0,08) und weniger als vier Hirnmetastasen (p = 0,06).

Schlussfolgerung:

Patienten mit Hirnmetastasen eines kolorektalen Karzinoms, die eine alleinige WBRT erhalten, scheinen von einer Dosiseskalation über 10 × 3 Gy hinaus zu profitieren.

Schlüsselwörter:

Kolorektales Karzinom Hirnmetastasen Dosiseskalation Gesamtüberleben Lokale Kontrolle 

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Copyright information

© Urban & Vogel, Muenchen 2010

Authors and Affiliations

  • Christine Heisterkamp
    • 1
  • Tiina Haatanen
    • 2
  • Steven E. Schild
    • 3
  • Dirk Rades
    • 1
    • 4
  1. 1.Department of Radiation OncologyUniversity Hospital Schleswig-HolsteinLübeckGermany
  2. 2.Department of Radiation OncologyUniversity Hospital Hamburg-EppendorfHamburgGermany
  3. 3.Department of Radiation OncologyMayo ClinicScottsdaleUSA
  4. 4.Department of Radiation OncologyUniversity of LübeckLübeckGermany

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