YO27 - Comparative Study Of 20Gray/5Fraction And 30Gray/10 Fraction Whole Brain Radiation In Brain Metastasis

Case summary

Whole Brain Radiotherapy plays a pivoted role in brain metastases. There is controversy regarding the radiotherapeutics dose fractionation in brain metastasis. 30 Gray in 10 fractions in 2 weeks in the standard regimen in most centers. Regarding the extraordinary poor survival prognosis of patients with brain metastasis, 20 Gray in 5 fractions over 1 week would be preferable. An observational comparative analytical study was conducted in National Academy of Medical Sciences (NAMS) Bir Hospital after ethical approval from the institutional review board of NAMS. Patients were randomized into two group one with 20 Gray in 5 fraction over one week and other with the 30Gray in 10 Fraction over 2 weeks. A total number of 55 patients were enrolled in the study. Assessment of clinical symptoms was done using Common terminology Criteria for Adverse Events (CTCAE), before treatment, just after treatment and 6 weeks of treatment. Response evaluation criteria in solid tumors (RECIST) was used to access the treatment response in terms of local control. Acute toxicity of the patients were assess during treatment and then followed for 6 weeks and graded according to Radiation Therapy Oncology Group (RTOG) acute radiation morbidity scoring. Of the 55 patients enrolled, in 20Gray/5# (n=28) and 30Gray/10# (n=26) groups, all participants in the study received the planned treatment of radiotherapy. Local control with complete or partial response was 63% in 20Gray v 48% in 30Gray (p = 0.722). Six month survival was 29.1% in 20Gray/5# v 23.6% in 30Gray/10# (p = 0.504). Objective Responsive of Headache was 53% v 52% (p= 0.469), vomiting 43% v 55%,(p=0.956),Seizure 11.7% v 3.7% (p = 0.979), focal weakness 21.3% v 4.4% (p=0.249), ataxia1 4.3% v 3.7% (p=0.281), speech disorder 3.5% v 7.4% (p=0.147), acute toxicities of grade 2 and grade 3 were acceptable in both Groups, nausea 9.1% v 9.1% ( p =0.907), vomiting 1.9% v 3.7% (p=0.199) , headache 1.9% v 3.7% (p=0.696) and Dermatitis 5.7% v 5.7% (p =0.140) 20Gray in 5fractions and 30Gray in 10 Fractions are equally effective and feasible as statistically insignificant difference in the response rate and acute toxicities were observed in the two groups

Clinical trial identification

Editorial acknowledgement