PROGNOSIS OF PATIENTS TREATED FOR INTRACRANIAL METASTASES WITH WHOLE-BRAIN IRRADIATION

Seventy-five patients with brain metastases from solid tumours were tr eated with whole-brain irradiation at our institution between 1990 and 1993. The primary cancers included 35 cases of lung cancer, 19 cases of breast cancer, nine cases of renal-cell cancer, six cases of melano ma and six cases of other primary sites. In each case the total dose t o the whole brain was at least 25 gray (Gy). The primary site, age, pe rformance status, number of brain metastases and the presence of extra cranial disease were studied as prognostic factors for survival. The m edian survival for the whole population was 4 months (range 1-62 month s). The patients with the brain as the only metastatic site had signif icantly better survival (P = 0.019) than those with both intracranial and extracranial metastatic sites. Poor performance status at the time of diagnosis of brain metastases was also related to short survival ( P = 0.001). None of the other studied variables had prognostic signifi cance. Four of the 75 patients with primary tumour sites in the breast (two patients) and the kidney (two patients) survived for more than 2 years. In general, patients with breast cancer had better survival th an patients with other primary cancers. Our study confirms the general ly poor prognosis of cancer with brain metastases, although individual patients may survive several years after whole-brain irradiation. App roximately two-thirds of the patients experienced a relief in symptoms allowing a reduction in the dose of corticosteroid medication, which clearly supports the use of whole-brain radiotherapy as a palliative t reatment.