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Radiation for Brain Metastases

Most patients with brain metastases are treated with whole brain radiation since the side effects of brain radiation (hair loss, skin irritation, fatigue) are minor and since many chemotherapy drugs are not effective for brain mets because of the blood-brain barrier (drugs may not penetrate into the brain.) As noted below about 80% of the patients benefit from brain radiation and the usual course of treatment (10 treatments of 300cGy per dose) takes only two weeks. Some patients may benefit from being treated a second time (re-irradiation) as noted below.

Brain Mets and Response to Radiation
  • 70 -90% initial response
  • > 50% of symptoms of headache, CSF pressure have complete response
  • 50 -60% have functional improvement
  • moderate dysfunction: 1/3 near normal at median time of 3 weeks
  • severe dysfunction: 2/3 improve at median of 1-2 weeks
  • time to progression is 2 -3  months
  • RTOG palliative index, 75-80% remaining life is palliated

Re-Irradiation of Brain Metastases
  • 70% response rate (in lit. 42-75%)
            27% have complete response
            43% partial response
  • Survival of 4 months (in lit. 3.5 - 5 months)

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