
<b>Whole brain irradiation is meant to decrease growth of more metastases, prophylactically.
It can increase survival time.</b>

However, there are symptoms from its use. "Early toxicity consisted of headache, nausea, fatigue, concentration problems and alopecia. These symptoms and signs were mild and usually reversible within a few months. Late toxicity was studied in patients whose survival exceeded two years." Seven of the prophylactically irradiated survived for more than two years, while no control patients survived for more than two years. "Memory problems were seen in six of the seven patients. These problems were non-disabling and, once established, remained stable for months to years. The most prominent radiologic abnormalities were cortical atrophy and leukoencephalopathy, found in four of the five patients who underwent radiologic follow-up examination. "J Neurooncol 1997 Nov;35(2):153-60

"In patients with brain metastasis from lung cancer, we have been able to control local recurrence in approximately 80% of cases. But many of them tend to show brain atrophy with mental deterioration developing a few months after whole brain radiation. To prevent brain atrophy, we have attempted treating patients, whose metastasis was diagnosed as single, by intra-operative radiotherapy (IOR) alone following surgical resection ,,,"  Acta Neurochir (Wien) 1994;131(1-2):91-6


<b>Whole Brain Irradiation -- Annotated Citations</b>


Radiology 1999 Sep;212(3):755-9 
<b>Phases IB and II multidose trial of gadolinium texaphyrin, a radiation sensitizer detectable at MR imaging: preliminary results in brain metastases. </b>
Viala J, Vanel D, Meingan P, Lartigau E, Carde P, Renschler M. Department of Radiology, Institut Gustave-Roussy, Villejuif, France. 

,,,, , and to determine an appropriate intravenous dose of gadolinium texaphyrin [a tumor-selective radiation sensitizer that is detectable at MR imaging ],,, and the response to treatment. 

Ten daily intravenous injections of gadolinium texaphyrin, each followed by whole-brain radiation therapy (total of 10 fractions, 30 Gy), were administered to patients with brain metastases in a multicenter study. ,,, 

MR imaging revealed selective drug uptake in metastases, without enhancement of normal brain tissue. In 10 patients, tumor uptake was higher after the 10th injection than after the first injection, which indicated accumulation of gadolinium texaphyrin in metastases. One lesion was visible only after the 10th injection ,,,. Response to treatment was defined as a reduction in the size of the metastases ,,,; seven patients achieved partial remission with tumor regression exceeding 50% of the initial size, and four achieved a minor response with less than 50% tumor regression. 

These preliminary results indicate that gadolinium texaphyrin is tumor selective and that brain metastases can be depicted at MR imaging long after the administration of gadolinium texaphyrin. phase i Clinical trial, phase ii Multicenter study 
&&url PMID: 10478243 


Radiother Oncol 1998 Jan;46(1):29-32 
<b>Brain-only metastases of small cell lung cancer; efficacy of whole brain radiotherapy. An EORTC phase II study.</b> 
Postmus PE, Haaxma-Reiche H, Gregor A, Groen HJ, Lewinski T, Scolard T, Kirkpatrick A, Curran D, Sahmoud T, Giaccone G. Free University Hospital Amsterdam, The Netherlands. 

...To evaluate the efficacy of WBRT as a single treatment modality in patients with brain metastases of small cell lung cancer. 
 ,,,. Twenty ,,, patients were evaluable for response. In six patients a complete response was seen and in five patients a partial response was seen giving a response rate of 50% ,,,. Response duration was 5.4 months (range 63-260 days) and median survival was 4.7 months (range 14-743 days). In the majority of patients the first site of progression after WBRT was in the central nervous system. Twelve of the patients had stabilization or improvement of the neurological function. 
...WBRT for brain metastases of small cell lung cancer gives a 50% response rate with stabilization or improvement of neurological function. Response duration and survival are short. Clinical trial, phase ii Multicenter study 
&&url PMID: 9488124 


Radiother Oncol 1997 Oct;45(1):17-22 
<b>Accelerated radiotherapy for brain metastases.</b> 
Nieder C, Nestle U, Niewald M, Schnabel K. Department of Radiotherapy, University Hospital, Homburg/Saar, Germany. 

...Two novel fractionation schedules for whole-brain irradiation were applied to patients with brain metastases. ...We applied 2 x 2.5 Gy/day to a total dose of 30 Gy (schedule 1) or 2 x 1.8 Gy/day to a total dose of 50.4 Gy (schedule 2) ,,,The 30 Gy schedule was also used in adjuvant treatment for resected brain metastases. We compared the results of 15 patients who underwent the 50.4 Gy schedule and 47 patients who were treated up to 30 Gy with those of a historical patient group, treated with one daily fraction of 3 Gy up to 30 Gy (n = 283). 

...  no therapeutic gain was seen for the 50.4 Gy group. Patients treated with the accelerated 30 Gy schedule had a significantly worse progression-free survival and a higher rate of late radiation toxicity than the historical group. In contrast, no severe acute toxicity was observed. 
...Considering progression-free survival and late toxicity, the accelerated 30 Gy schedule cannot be recommended ,,,. Radiotherapy with a higher total dose (50.4 Gy) showed no advantage. Controlled clinical trial 
&&url PMID: 9364627 


J Neurooncol 1997 Nov;35(2):153-60 
<b>Efficacy and safety of prophylactic cranial irradiation in patients with small cell lung cancer. </b>
van de Pol M, ten Velde GP, Wilmink JT, Volovics A, Twijnstra A. Department of Neurology, University Hospital Maastricht, The Netherlands. 

...Prophylactic cranial irradiation (PCI) as part of the treatment regimen for patients with limited stage small cell lung cancer (SCLC) remains controversial. 
...thirty-nine patients with limited stage SCLC who had shown complete remission after chemotherapy were enrolled prospectively into the non-randomized study. Eighteen of them received PCI (PCI+), while 21 did not (PCI-). ...

The frequencies of brain metastases were not significantly different between the groups (Fisher's exact test, p = 0.207), but brain metastases in PCI+ patients tended to occur later (log rank, p = 0.008). Overall survival was significantly longer in PCI+ patients (log rank, p &lt; 0.001). Early toxicity consisted of headache, nausea, fatigue, concentration problems and alopecia. These symptoms and signs were mild and usually reversible within a few months. Late toxicity was studied in patients whose survival exceeded two years. Seven PCI+ patients survived for more than two years, while no PCI- patients survived for more than two years. Memory problems were seen in six of the seven patients. These problems were non-disabling and, once established, remained stable for months to years. The most prominent radiologic abnormalities were cortical atrophy and leukoencephalopathy, found in four of the five patients who underwent radiologic follow-up examination. 
...This non-randomized study suggests that PCI may be effective by decreasing the frequency of brain metastases and by increasing the brain metastasis-free survival and overall survival, with a minor risk of clinical and radiologic neurotoxicity. Clinical trial 
&&url PMID: 9266453  


Am J Clin Oncol 1997 Apr;20(2):158-60 
<b>The role of hyperfractionated re-irradiation in metastatic brain disease: a single institutional trial. </b>
Abdel-Wahab MM, Wolfson AH, Raub W, Landy H, Feun L, Sridhar K, Brandon AH, Mahmood S, Markoe AM. Department of Radiation Oncology, University of Miami School of Medicine, Florida 33136, U.S.A. 

Progression of brain metastases after brain irradiation has prompted several studies on retreatment of the brain. Increased durations of survival and improved quality of life have been reported. 
Fifteen patients with previously treated brain metastases were entered into this pilot study between May 1990 and January 1994. All patients had neurologic and/or radiologic evidence of progression of brain metastases. ,,, The median interval between the first treatment and retreatment was 10 months. All patients received whole-brain irradiation with or without a boost for their initial treatment course. Doses ranged from 3,000 to 5,500 cGy for initial treatments (median, 3,000). Retreatment consisted of limited fields ... Patients were retreated with a median dose of 3,000 cGy (range, 600-3,000 cGy). A median cumulative dose of 6,000 cGy was achieved. 

,,, Retreatment was tolerated without serious complications. Of the 15 patients treated, nine (60%) experienced improvement, and five (27%) had stabilization of neurologic function and/or radiographic parameters. Median survival was 3.2 months; two of the reirradiated patients survived >or = 9 months.

<b>reirradiation is a viable option in patients with recurrent metastatic lesions of the brain, and the use of a limited retreatment volume makes this a well-tolerated, low-morbidity treatment that leads to clinical benefits and, in some instances, enhanced survival.</b> The influence of hyperfractionation on the outcome needs to be investigated further in large series. Clinical trial 
&&url PMID: 9124191 


Acta Neurochir (Wien) 1994;131(1-2):91-6 
<b>New treatment protocol by intra-operative radiation therapy for metastatic brain tumours. </b>
Nakamura O, Matsutani M, Shitara N, Okamoto K, Kaneko M, Nakamura H, Asai A, Ueki K, Shimizu T, Tanaka Y, et al. Department of Neurosurgery, Tokyo Metropolitan Komagome Hospital, Japan. 

<b>In patients with brain metastasis from lung cancer, we have been able to control local recurrence in approximately 80% of cases. But many of them tend to show brain atrophy with mental deterioration developing a few months after whole brain radiation. To prevent brain atrophy, we have attempted treating patients, whose metastasis was diagnosed as single, by intra-operative radiotherapy (IOR) alone following surgical resection</b> ,,, 
&&url PMID: 7709790 
