Tuesday, August 2, 2005
This month's J of Pain and Symptom Management has an interesting article about symptoms after whole brain irradiation for brain metastases . This was a prospective cohort study using the Edmonton symptom assessment scale; average baseline Karnofsky score was 60. Essentially they found no significant change in symptoms with the exception of slight worsening in fatigue, drowsiness, and appetite after the WBI at 12 weeks. Median survivial was 8 weeks however, and they raise the question of the benefits of WBI in people who are likely to die within a few months. They conclude by recommending a trial of dexamethasone alone vs WBI in this population, which sounds like a good idea of course, but selecting out those who have "anticipated short survival" would be tricky.
The benefits of whole brain radiotherapy in brain metastases patients with poor performance status, extensive active extracranial disease, and anticipated short survival have been questioned. The magnitude of benefit using whole brain radiotherapy above dexamethasone alone in this subset of patients remains uncertain. There has been a proposal of a trial of dexamethasone alone versus radiotherapy and dexamethasone in patients with poor performance status and anticipated short survival.