Rationale for the Use of Upfront Whole Brain Irradiation in Patients with Brain Metastases from Breast Cancer
Abstract
:1. Introduction
2. Results
2.1. Whole Brain Radiation Therapy (WBRT) Alone
2.2. Protraction
2.3. WBRT and Radiosensitizers
2.4. Radio-Chemotherapy
2.5. WBRT and Targeted Therapies
2.6. Role of a Boost Added to WBRT
2.7. Role of WBRT after Radiosurgery
2.8. WBRT ± Surgery
2.9. Surgery ± WBRT
3. Discussion
4. Materials and Method
5. Conclusions
Conflicts of Interest
- Author ContributionsAT, DA, AG and PM contributed to the conception as well as the preparation of the manuscript. AT, DA, ELR, FB, AFC, AG, ST, FD, JPS and PM performed the literature search, and AT, ELR, AG, ST, PM wrote the manuscript. DA, FB, AFC, FD, JPS performed critical revision; all authors read and approved the final version of the manuscript.
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Study | Ref. | N | BM number | Radiation schedule | Response rate * (%) | Recurrence rate (%) |
---|---|---|---|---|---|---|
Nieder et al., 1997 | [7] | 46 | Median:4 | 30 Gy/10 f | 65 a | 0 |
Ogura et al., 2003 | [9] | 36 | Multiple | −30 Gy/10 f −50 Gy/25 f Boost: 10 pts | 82 b | 32 |
Mahmoud-Ahmed et al., 2002 | [10] | 116 | Single:20 2–3:38 4–9:50 >9:8 | 30 Gy/10 f | NR | 50 |
Le Scodan et al., 2007 | [11] | 117 | Multiple | 30 Gy/10 f | NR | 42.5 |
Study | Ref. | Randomization arm | N | Primary (%) | Median survival (months) | 6-Month survival | Response Rate |
---|---|---|---|---|---|---|---|
Komarnicky et al., 1991 | [19] | 30 Gy/6 fr + misonidazole | 196 | L: NR B: NR O: NR | 3.1 | 68 | NR |
30 Gy/6 fr | 200 | 4.1 | 83 | ||||
30 Gy/10 fr + misonidazole | 190 | 3.9 | 65 | ||||
30 Gy/10 fr | 193 | 4.5 | 72 | ||||
Mehta et al., 2003 | [20] | 30 Gy/10 fr + MGd | 193 | L: 62% | 5.1 | 82 | NR |
B: 19% | |||||||
30 Gy/10 fr | 208 | O: 19% | 5.8 | 85 | |||
p = 0.68 | |||||||
Suh et al., 2006 | [21] | 30 Gy/10 fr + O2 + efaproxiral | 265 | L: 56% | 5.4 | NR | 46 |
B: 21% | 38 | ||||||
30 Gy/10 fr + O2 | 250 | O: 23% | 4.4 | p = 0.1 | |||
p = 0.16 | |||||||
Knisely et al., 2008 | [22] | 37.5 Gy/15 fr + thalidomide | 84 | L: 62% | 3.9 | 26% | NR |
B: 18% | |||||||
37.5 Gy/15 fr | 92 | O: 20% | 3.9 | 28% | |||
p = 0.88 |
Study | Ref. | Randomization arm | N | Primary | Median survival (months) | Response rate |
---|---|---|---|---|---|---|
Antonadou et al., 2002 | [25] | 40 Gy/20 fr | 23 | L: 83% | 7.0 | 67% |
B: 11% | ||||||
40 Gy/20 fr + TMZ | 25 | O: 6% | 8.6 NS | 96% (p = 0.017) | ||
Verger et al., 2005 | [26] | 30 Gy/10 fr | 41 | L: 51% | 3.1 | 32% |
B: 16% | ||||||
30 Gy/10 fr + TMZ | 41 | O: 33% | 4.5 NS | 32% (p = NS) |
Study | Ref. | BM treatment | Radiation schedule | Patients number | Median survival (months) | p |
---|---|---|---|---|---|---|
Patchell et al., 1990 | [39] | Biopsy + WBRT | 36 Gy/12 fr | 23 | 3.4 | <0.01 |
Surgery + WBRT | 25 | 9.2 | ||||
Vecht et al., 1993 | [40] | WBRT | 40 Gy/20 BID | 31 | 6 | 0.04 |
Surgery + WBRT | 32 | 10 | ||||
Mintz et al., 1996 | [41] | WBRT | 30 Gy/10 fr | 43 | 6.3 | 0.24 (NS) |
Surgery + WBRT | 41 | 5.6 |
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Tallet, A.V.; Azria, D.; Rhun, E.L.; Barlesi, F.; Carpentier, A.F.; Gonçalves, A.; Taillibert, S.; Dhermain, F.; Spano, J.-P.; Metellus, P. Rationale for the Use of Upfront Whole Brain Irradiation in Patients with Brain Metastases from Breast Cancer. Int. J. Mol. Sci. 2014, 15, 8138-8152. https://doi.org/10.3390/ijms15058138
Tallet AV, Azria D, Rhun EL, Barlesi F, Carpentier AF, Gonçalves A, Taillibert S, Dhermain F, Spano J-P, Metellus P. Rationale for the Use of Upfront Whole Brain Irradiation in Patients with Brain Metastases from Breast Cancer. International Journal of Molecular Sciences. 2014; 15(5):8138-8152. https://doi.org/10.3390/ijms15058138
Chicago/Turabian StyleTallet, Agnes V., David Azria, Emilie Le Rhun, Fabrice Barlesi, Antoine F. Carpentier, Antony Gonçalves, Sophie Taillibert, Frédéric Dhermain, Jean-Philippe Spano, and Philippe Metellus. 2014. "Rationale for the Use of Upfront Whole Brain Irradiation in Patients with Brain Metastases from Breast Cancer" International Journal of Molecular Sciences 15, no. 5: 8138-8152. https://doi.org/10.3390/ijms15058138