Efficacy and Toxicity of Short Course and Ultra-Short Course Radiotherapy in Metastatic Brain Cancer
Keywords:
Brain metastases, Whole-brain radiotherapy, Hypofractionation, Palliative radiotherapy, Acute toxicityAbstract
Background: The occurrence of brain metastasis represents a critical event in the progression of malignant disease. Whole brain radiotherapy (WBRT) with 20 Gray administered in 5 fractions (short course) is a commonly employed treatment protocol for metastatic brain cancer. Given the limited survival associated with brain metastasis, a shorter WBRT regimen of 12 Gray in 2 fractions (ultra-short course) has been proposed as an alternative.
Aim of the study: This study aimed to compare the efficacy, including response rates and toxicities, of ultra-short-course versus short-course whole-brain radiotherapy in patients with brain metastasis.
Method: This quasi-experimental study included 118 patients who met the inclusion and exclusion criteria between January 2018 and June 2019. Participants were enrolled using convenience and purposive sampling and were allocated equally into two groups (n=59 each). Group A received ultra-short-course, and Group B received short-course WBRT. Follow-up assessments were conducted at one, two, four, and eight weeks after completion of radiotherapy. Each follow-up included clinical examination and relevant laboratory investigations. Data were compiled and analyzed using SPSS (Version 24.0) employing the chi-square test and Fisher’s exact test.
Results: The most common symptoms associated with brain metastases were headache, nausea, vomiting, convulsions, and cognitive dysfunction. For Grade 3 headache, response rates were 76.19% in the ultra-short-course group and 75.00% in the short course group (p-value <0.05). For Grade 2 nausea, response rates were 54.55% in Arm A and 56.25% in Arm B (p-value <0.05). Therapeutic response rates for vomiting, convulsions, and cognitive dysfunction were similar between both groups. Fatigue, skin reactions, and alopecia were identified as common acute toxicities of whole brain radiotherapy, with comparable frequencies in both arms. These toxicities were manageable with appropriate supportive measures.
Conclusion: Ultra-short-course whole brain radiotherapy demonstrates comparable effectiveness to short course radiotherapy for palliation of symptoms in metastatic brain cancer. This approach may facilitate treatment of a greater number of patients using existing resources, with manageable toxicities.
J MEDICINE 2026; 27(2): 86-93
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