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RESULTS
Patient, tumor, and treatment characteristics at initial
presentation are listed in Table 1. The median age at initial
presentation of brain metastasis was 55 (range, 29 to 77). Non
small cell lung cancer (39%), small cell lung cancer (24%),
and breast cancer (18%) were the most common primary sites.
The median number of lesions treated at initial WBRT was 4
(range, 1 to 21). Thirteen patients (27%) had 1 brain lesion at
initial diagnosis. At initial diagnosis of brain metastasis, 3
patients in this cohort had leptomeningeal disease (LMD), 40
patients (82%) had extracranial disease, and 24 patients (49%)
had controlled primary disease. The median initial dose of
WBRT was 30 Gy in 10 fractions (fx) (range, 20 to 37.5 Gy).
At diagnosis, 51% of patients had Karnofsky performance
status (KPS) of 90 to 100 and 82% were Radiation Therapy
Oncology Group recursive partitioning analysis Class II.
The median interval between the initial diagnosis of brain
metastases and relapse requiring repeat WBRT was 11.5
months (range, 1.5 to 49.2 mo). Relapse was detected by MRI
in 86% of patients and CT in 14% of patients.
Patient, tumor, and treatment characteristics at relapse are
listed in Table 2. The median age at repeat WBRT was 56
(range, 30 to 78) and median KPS was 70 (range, 40 to 90).
TABLE 1. Patient, Tumor, and Treatment Characteristics for 49
Repeat WBRT Patients at Initial Presentation
n (%)
Primary site
NSCLC
SCLC
Breast
Melanoma
Other
KPS at diagnosis
r70
80
90-100
RPA class at diagnosis
I
II
III
Dose/fractionation of initial WBRT
20 Gy/5 fx
30 Gy/10 fx
37.5 Gy/15 fx
Symptom response to initial WBRT
Asymptomatic
Complete or partial response
Stable or progression
19
12
9
3
6
(39)
(24)
(18)
(6)
(12)
n (%)
KPS at relapse
r70
80
90-100
Extracranial disease at relapse
No
Yes
Dose/fractionation of repeat WBRT
20 Gy/10 fx
20 Gy/5 fx
Other*
29 (59)
15 (31)
5 (10)
3 (6)
46 (94)
28 (57)
16 (33)
5 (10)
6 (12)
18 (37)
25 (51)
7 (14)
40 (82)
2 (4)
1 (2)
38 (78)
10 (20)
19 (39)
4 (8)
26 (53)
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n (%)
Clinical symptoms response to repeat WBRT
Improved
Stable
Progression
Not available
Radiographic response to repeat WBRT
Improved
Stable
Progression
Not available
13
12
14
10
(27)
(24)
(29)
(20)
10
4
8
27
(20)
(8)
(16)
(55)
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DISCUSSION
This
Study
n
Initial RT
Repeat WBRT
Interval (mo)
Response (%)
Improved
Stable
None
Toxicity
Shehata
et al10
Kurup
et al11
Hazuka
and
Kinzie12
Cooper
et al13
49
35
56
44
52
30 Gy/ 10 Gy/1 fx 18 Gy/3 fx 30 Gy/10 30 Gy/10
10 fx 30 Gy/10 fx
fx
fx
20 Gy/ 10 Gy/1 fx 20 Gy/10 25 Gy/8 fx 25 Gy/10
10 fx
fx
fx
Wong
et al14
86
30 Gy/10 fx
20 Gy/10 fx
AbdelWahab
et al15
15
30 Gy/15
fx
30 Gy/20
fx (twice
daily)
10
(median)
Sadikov
et al16
Son et al17
72
20 Gy/5 fx
17
35 Gy/14 fx
25 Gy/10 fx
21.6 Gy/12 fx
9.6 (median)
15 (median)
11.5
(median)
6.3 (mean)
7.8
(median)
>4
7.6 (median)
27
24
29
68
25
75
12.5
12.5
27
41
14
42
52
6
70
29
60
27
40
33
33
5 patients w/
radiographic
abnormality
4 (median)
1 patient memory
loss, pituitary
insufficiency
4.1 (median)
80
20
Stable or no
response
71% at least
1 acute side
effect
5.2 (median)
4.1 (median)
2.6 (median)
No
83% no
17.8%
8
3.5
2
4
(median)
(median) (median) (median)
Survival after
repeat WBRT
(mo)
Time to progression
1.7
after repeat
(median)
WBRT (mo)
2.5
3.2
(median)
2.75
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CONCLUSIONS
Repeat WBRT was tolerable and safe in the vast majority
of our patients and those reported in the literature. Modest
survival times are seen after reirradiation. Potential prognostic
factors for survival in our series include improvement of
neurological symptoms after reirradiation and higher KPS at
first follow-up. Although SRS is increasingly used for salvage
treatment of brain metastases after prior WBRT, repeat WBRT
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