The palliation of brain metastases in a favorable patient population: A randomized clinical trial by the radiation therapy oncology group

The palliative effectiveness of a short, intensive course of brain irradiation (3000 rad in 2 weeks) was compared to that of a high-dose course (5000 rad in 4 weeks) in a randomized RTOG clinical trial. Eighty percent of the 255 evaluable patients had lung primaries, 7% breast, and 13% other or unknown primaries. Patients with evidence of extra-cranial metastases, uncontrolled primaries, or Class IV Neurologic Function (NFIV) were excluded. Forty-one percent of NFII and 71 % of NFIV patients improved in neurologic function class. For NFII patients, a significantly greater improvement rate was obtained with the short course than with the long course. Otherwise there were no significant differences between the two regimens with respect to palliation of symptoms, improvement rate, median time to progression, cause of death, or median survival. We conclude that 3000 rad in two weeks is at least as effective as 5000 rad in four weeks in the palliation of brain metastases, even in this relatively favorable patient population.