Re-irradiation for Metastatic Brain Tumors with Whole-brain Radiotherapy

To determine whether second whole-brain irradiation is beneficial for patients previously treated with whole-brain irradiation. A retrospective analysis was done for 31 patients with brain metastases who had undergone re-irradiation. Initial whole-brain irradiation was performed with 30 Gy/10 fractions for 87 of these patients. Whole-brain re-irradiation was performed with 30 Gy/10 fractions for 42 of these patients (340 Gy/120 fractions). Three patients underwent a third whole-brain irradiation. The median interval between the initial irradiation and re-irradiation was 10 months (range: 269 months). The median survival time after re-irradiation was 4 months (range: 121 months). The symptomatic improvement rate after re-irradiation was 68, and the partial and complete tumor response rate was 55. Fifty-two percent of the patients developed Grade 1 acute reactions. On magnetic resonance imaging, brain atrophy was observed in 36 of these patients after the initial irradiation and 74 after re-irradiation. Grade epsilon 2 encephalopathy or cognitive disturbance was observed in 10 patients (32) after re-irradiation. Based on univariate analysis, significant factors related to survival after re-irradiation were the location of the primary cancer (P 0.003) and the Karnofsky performance status at the time of re-irradiation (P 0.008). A Karnofsky performance status epsilon 70 was significant based on multivariate analysis (P 0.050). Whole-brain re-irradiation for brain metastases placed only a slight burden on patients and was effective for symptomatic improvement. However, their remaining survival time was limited and the incidence of cognitive disturbance was rather high.