Observation Of Short Term Therapeutic Effectiveness Of Whole Brain Radiotherapy Combined With Local Boost Radiotherapy For Patients With Brain Metastasis

Brain metastases occur in 20 to 40% of patients with cancer. Addi- tionally, the incidence of brain metastasis appears to be increasing likely due to the number of systemic cancer patients living long enough to develop metastases as a result of improved primary cancer therapies. Brain metastasis is one of the main causes of death for cancer patients, whose mean survival time is 1–2 months. Whole-brain radiation therapy (WBRT) has been the standard treatment for all patients with brain metastasis. But for whole brain radiotherapy, the recurrence rate of nidi is relatively high, because irradiation dose to the whole brain has to be limited in case that irreversible nerve tissue complications result from whole brain radiotherapy. The clinical research demonstrates that applying the booster dose of local radiotherapy after whole brain irradiation is better than sole whole brain irradiation in enhancing the control rate of tumors, reducing local recrudescence, improving patients'symptoms and signs, elevating KPS grade and extending lifetime. After combining radiotherapy, dose to the metastasis can be increased above 60 Gy, which, however, does not affect peripheral normal tissue greatly. But recently, that is questioned, if the WBRT needed add to the local treatment of brain met- astases. Aoyama et al showed that the Mini Mental State Examination of the patients is improved after the treatment of focal therapeutic, but they are po- orly understood. Therefore, some scholars prefer the local treatment of brain metastases. Purpose:To observe the recently therapeutic effects and toxicity of whole brain radiotherapy combined with local boost radiotherapy for patients with brain metastasis.Method:The clinic data of 36 patients with brain metastases and stable extracranial lesions from December 2009 to December 2010 were assigned into the WBRT alone group (A group),the WBRT with 3-CRT or SRS boost group (B group) and the focal radiation to tumors alone group (C group). The patients of the WBRT alone group accepted the radiation therapy for 4 to 5 weeks, and then into the assessment phase. The patients of the B group accepted the radiation therapy for 3 to 4 weeks, as the WBRT alone group, then they accept the 3D-CRT or the SRT according to the location,number or the size of the tumor in the brain. The patients of the C group accepted the radiation therapy to the tumors only , Than we evaluated the control rate and the remission rate, after first months. And observed changes of the main symptom, the Quality of life,and the adverse events during the progress.Result:The control rates and the remission rates of the B group and C group are significantly higher the A group, they are statistically significant means. The main symptoms and the changes in the Quality of life of the combined treatment group are significantly higher than the WBRT alone group, they are statistically significant means. The adverse events during the progress are significant different too, But the C group is the least.Conclusion;From this study, we know that the combined treatment of the WBRT with 3-CRT or SRS boost and the focal radiation to tumors alone can improve the short-term intracranial remission rates and the control rates for the patients with brain metastases. They can remit neural symptoms and signs, improve life quality, too.The combined treatment of the WBRT with 3-CRT or SRS boost and the focal radiation to tumors alone doesn't significantly aggravate toxicity of radiotherapy. The adverse events during the progress are not significant different.