Palliative radio-chemotherapy with ifosfamide and BCNU for breast cancer patients with cerebral metastases

Summary

Between January 1983 and April 1989, 61 patients with brain metastases of primary breast cancer were treated in the Robert Janker Clinic. To optimize the overall response rates, a simultaneous combination of radiation and chemotherapy was used. The patients median age was 49 (range, 30–67) years and the median performance score, 1 (0–2). The average interval between the diagnosis of the primary tumour and the brain metastases was 38 (range, 3–144) months. A total of 82% of the patients had multiple cerebral metastases. All patients had been pretreated with primary surgery; 79%, with radiation; 74%, with chemotherapy; and 64%, with hormones. Radiotherapy was given using a cobalt 60 machine. The whole brain was irradiated in daily fractions of 1.5 Gy, up to a total dose of 45 Gy. Using a split-course technique, this dose was given in three courses simultaneously with the chemotherapy. The chemotherapeutic regimen consisted of ifosfamide given daily for 5 days at 2 g/m² and the nitrosourea derivative carmustine (BCNU) given at 30 mg/m² on 3 days. The toxicity of the treatment was moderate; no haemotological or gastro-intestinal complications occurred. Complete and mostly irreversible alopecia occurred in all cases. All patients received a cranial computerized tomographic (CT) scan prior to and after treatment. According to the criteria of the International Union Against Cancer (UICC), there was a complete remission (CR) in 20% of the patients and a partial remission (PR) in 45%; 20% had a minor remission (MR) and 7% showed no change (NC) in the tumour. Another 7% of the patients experienced a progression of their metastases (PD). The median survival was 8 months for all patients and 12 months for those showing a CR.