Comparison of Long-Course and Short-Course Whole-Brain Radiotherapy for Brain Metastases: A Prospective Randomized Study

Abstract

Background: Brain metastases represent the most common intracranial malignancy in adults and remain a major therapeutic challenge. Whole-brain radiation therapy (WBRT) continues to be an important palliative treatment modality for patients with symptomatic brain metastases. However, the optimal fractionation schedule remains a subject of clinical consideration, particularly regarding symptom control, survival outcomes, and healthcare resource utilization. This prospective randomized study aimed to compare overall survival outcomes between two WBRT fractionation schedules and to identify prognostic factors associated with survival.

Materials and Methods: A total of 60 previously untreated patients with symptomatic brain metastases were prospectively randomized to receive WBRT using either a long-course regimen (30 Gy delivered in 10 fractions;
Arm A) or a short-course regimen (20 Gy delivered in 5 fractions; Arm B). Patients were evaluated during treatment and at 1, 3, 6, 9, and 12 months after completion of WBRT. Overall survival, treatment response, prognostic factors, and quality of life outcomes were assessed.

Results: At 12 months after WBRT, the objective response rate (complete and partial responses) was 8.0% in Arm A and 16.66% in Arm B. No significant difference in overall survival was observed between the two treatment groups (p = 0.42). Multivariate Cox regression analysis demonstrated that the absence of extracranial metastases was significantly associated with improved survival at 12 months after WBRT, while age and the number of brain lesions showed trends toward better survival outcomes. Quality of life assessment using the EORTC QLQ-C30 questionnaire demonstrated comparable improvements in both groups.

Conclusions: Both WBRT fractionation schedules demonstrated comparable survival and quality-of-life outcomes in patients with symptomatic brain metastases. Short-course WBRT may represent a reasonable alternative for selected patients by reducing treatment duration and healthcare resource burden without compromising clinical outcomes.