Investigating the palliative efficacy of whole-brain radiotherapy for patients with multiple-brain metastases and poor prognostic features

Aims: Trials have shown that patients with multiple-brain metastases and poor prognostic features have a short median survival after whole-brain radiotherapy (WBRT). Quality of life (QoL) and other parameters to assess the palliative efficacy of WBRT have not previously been studied in this group of patients. We therefore attempted to do this. Materials and methods: We performed three studies between 1997 and 2001. The two later studies were designed according to the results from the preceding study. Each of them revealed the difficulties in studying this group of unwell patients with a short survival. Results: Thirty-eight patients were studied. They had at least two of three poor prognostic features, such as Karnofsky performance status (KPS) < 70, over 60 years of age, and primary other than breast cancer. The overall median survival was 8 weeks (95%, Cl 6-10). Twenty-four patients had a KPS < 70 and a median survival of 6 weeks (95% CI 4-9). At 8 weeks after WBRT, 14 out of 15 surviving patients for whom data were obtained suffered deterioration in QoL scores, Barthel or KPS. Ten of the 38 patients (26%, 95% CI 13-43%) improved in at least one of these parameters during the assessment period. Only three out of 38 patients discontinued steroids after the radiotherapy. Side-effects of WBRT were common. All patients experienced alopecia and lethargy after radiotherapy. Conclusions: Further trials involving larger numbers of patients are necessary. These studies offer further information on the limited response rates to WBRT, side-effects and effects on QoL, which need to be discussed with patients before they accept or decline the offer of cranial irradiation. (C) 2003 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.