Quality of life and symptoms control in brain metastasis after palliative whole brain radiotherapy using two different protocols.

OBJECTIVE To compare the quality of life and symptomatic improvement after palliative radiotherapy to brain metastasis using two different treatment protocols. STUDY DESIGN Comparative study. PLACE AND DURATION OF STUDY Bahawalpur Institute of Nuclear Medicine and Oncology, Bahawalpur, from January 2009 to November 2010. METHODOLOGY Patients presenting with brain metastasis referred to Bahawalpur Institute of Nuclear Medicine and Oncology, Bahawalpur for whole brain radiotherapy (WBRT) were included. Patients were divided in two groups. In group A WBRT 30 Gys in 10 fractions were given. While in group B 30 Gys in 15 fractions to whole brain followed by 20 Gys in 10 fractions boost to primary metastatic site with 2 cm margins were given. Follow-up was done at 1 and 3 months. RESULTS A total of 46 patients with brain metastasis were enrolled with median Karnofsky performance score 50. Median age was 64 years. Most common presenting symptoms were headache, weakness, balance problem and early fatigability. Fifty percent of patients had improvement in their presenting symptoms after completion of palliative radiotherapy at one month and three months follow-up. There was a statistically significant improvement in headache, nausea or vomiting, focal weakness, dizziness, balance problem and problems with smell, hearing and tingling sensation in group B patients as compared to group A. CONCLUSION More controlled and better quality of life was observed in patient given 30 Gys in 15 fractions followed by a boost of 20 fractions to primary metastatic site versus WBRT with 30 Gys in 10 fractions and in patients with metastatic sites are less than three and having difference not more than 2 cm apart between two metastatic sites.