• Glenn Bauman, Slav Yartsev, David Roberge, Robert MacRae, Wilson Roa, Valerie Panet-Raymond, Laura Masucci, Brian Yaremko, David D'Souza, David Palma, Tracy Sexton, Edward Yu, Jason R Pantarotto, Belal Ahmad, Barbara Fisher, A Rashid Dar, Carole Lambert, Gregory Pond, Larry Stitt, Keng Yeow Tay, and George Rodrigues.
• Division of Radiation Oncology, London Health Sciences Centre, A4-901B, 790 Commissioners Rd. E, London, ON, N6A4L6, Canada. glenn.bauman@lhsc.on.ca.
• J. Neurooncol. 2016 Jul 1; 128 (3): 431-6.

AbstractWe examined functional outcomes and quality of life of whole brain radiotherapy (WBRT) with integrated fractionated stereotactic radiotherapy boost (FSRT) for brain metastases treatment. Eighty seven people with 1-3 brain metastases (54/87 lung primary, 42/87 single brain metastases) were enrolled on this Phase II trial of WBRT (30 Gy/10) + simultaneous FSRT, (60 Gy/10). Median overall follow-up and survival was 5.4 months, 6 month actuarial intra-lesional control was 78 %; only 1 patient exhibited grade 4 toxicity (worsened seizures); most treatment related toxicity was grade 1 or 2; 2/87 patients demonstrated asymptomatic radiation necrosis on follow-up imaging. Mean (Min-Max) baseline KPS, Mini Mental Status Exam (MMSE) and FACT-BR quality of life were 83 (70-100), 28 (21-30) and 143 (98-153). Lower baseline MMSE (but not KPS or FACT-Br) was associated with worse survival after adjusting for age, number of metastases, primary and extra-cranial disease status. Crude rates of deterioration (>10 points decrease from baseline for KPS and FACT-Br, MMSE fall to <27) ranged from 26 to 38 % for KPS, 32-59 % for FACT-Br and 0-16 % for MMSE depending on the time-point assessed with higher rates generally noted at earlier time points (≤6 months post-treatment). Using a linear mixed models analysis, significant declines from baseline were noted for KPS and FACT-Br (largest effects at 6 weeks to 3 months) with no significant change in MMSE. The effects on function and quality of life of this integrated treatment of WBRT + simultaneous FSRT were similar to other published series combining WBRT + radiosurgery.

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