Published: 2019-09-23

Long-course versus short-course palliative cranial irradiation in brain metastases: a comparative study

Guncha Maheshwari, Manju Lata Yadav, Shankar Lal Jakhar, Neeti Sharma, H. S. Kumar, Aditya Dhanawat


Background: Brain metastases are the most common intracranial malignancy in adults and their management poses a significant healthcare problem. Of the various options available, whole brain radiotherapy (WBRT) remains the mainstay of treatment. Nonetheless, there is a need to develop fractionation schedules for best symptom palliation and prolonged survival. This prospective study aims to compare treatment outcome in terms of overall survival in two different WBRT schedules and determine the prognostic factors affecting this outcome.

Methods: Sixty previously untreated patients with symptomatic brain metastases were randomized in two arms of 30 patients each to receive WBRT. Arm A patients received 30Gy in 10 fractions (long-course) and arm B received 20Gy in 5 fractions (short-course). All patients were assessed during and after completion of WBRT at 1, 3, 6, 9 and 12 months.

Results: At 12 months post WBRT, the objective response rate i.e. complete and partial response (CR+PR) was 6.67% in arm A and 13.34% in arm B (p=0.96). Both WBRT regimens showed similar survival (p=0.65). On multivariate linear regression analysis, age ≤65 years, Karnofsky performance score (KPS) ≥70 and lack of extra-cranial metastases were significantly associated with improved survival at the end of 12 months post WBRT. EORTC QLQ-C30 showed similar improvement in quality of life in both the arms (p=0.86).

Conclusions: This study suggests comparable results in the two fractionation schedules. Therefore, short-course WBRT may be used as a more convenient option in favour of shorter hospital stay and lesser burden on RT machines.


Brain metastases, Fractionation schedules, Long course, Short course, Whole Brain Radiotherapy

Full Text:



Antonadou D. Current treatment of brain metastases. Eur Oncol Rev. 2005:1-5.

Davis PC, Hudgins PA, Peterman SB. Diagnosis of cerebral metastases: double dose delayed CT vs. contrast-enhanced MR imaging. AJNR Am J Neuroradiol. 1991;12:293-300.

Schouten LJ, Rutten J, Huveneers HA. Incidence of brain metastases in a cohort of patients with carcinoma of breast, colon, kidney, lung and melanoma. Cancer. 2002;94:2698-705.

Schellinger PD, Meinck HM. Thron A. Diagnostic accuracy of MRI compared to CCT in patients with brain metastases. J Neuro-Oncol. 1994;44:275-81.

Hwang TL, Close TP, Grego JM, Brannon WL, Gonzales F. Predilection of brain metastasis in gray and white matter junction and vascular border zones. Cancer: Interdisciplinary International J. of the ACS. 1996 Apr 15;77(8):1551-5.

Posner J. Management of central nervous system metastasis. Sem Oncol. 1977;4:81-91.

Chao JH, Phillips R, Nickson JJ. Roentgen-ray therapy of cerebral metastases. Cancer. 1954;7:682-9.

Gasper L, Scott C, Rotman M, Asbell S, Phillip T, Wasserman T, et al. Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trial. Inf. J Radiant Oncol Biol Phys. 1997;37:745-51.

Joiner M, Van der Kogel A. The Linear- Quadratic approach to fractionation and calculation of isoeffect relationship. In: Steel GG. ed. Basic Clinical Radiobiology. New York: Oxford; 1997:106-112.

Harwood AR, Simson WJ. Radiation Therapy of cerebral metastases: a randomized prospective clinical trial. Int. J Radiant Oncol Biol Phys. 1977;2:1091- 4.

Priestman TJ, Dunn J, Brada M, Rampling R, Baker PG. Final results of Royal College of Radiologists trial comparing two different radiotherapy schedules in the treatment of cerebral metastases. Clin Oncol. 1996;8:308-15.

Chatani M, Matayoshi Y, Masaki N, Inoue T. Radiation therapy for brain metastases from lung carcinoma. Prospective randomized trial according to the level of lactate dehydrogenase. Strahlenther Oncol. 1994:170:155-61.

Patil CG, Pricola K, Sarmiento JM, Garg SK, Bryant A, Black KL. Whole brain radiation therapy (WBRT) alone versus WBRT and radiosurgery for the treatment of brain metastases. Cochrane Database Syst Rev. 2017;9:CD006121.

Tsao MN, Lloyd NS, Wong RKS, Rakovitch E, Chow E, Laperriere N; Supportive Care Guidelines Group of Cancer Care Ontario’s Program in Evidence-based Care. Cancer Treat Rev. 2005 Jun:31(4):256-73.

Lagerwaard FJ, Levendag PC. Prognostic factors in patients with brain metastases. Forum (Genova) 2001;11:27-46.