Large dose increment irradiation in treatment of cerebral metastases

Fifty-four patients with cerebral metastases were treated with large dose increment radiation, usually in a single exposure of the whole brain. Thirty-one patients were males, with lung as the most frequent primary; 23 were females, with breast as the most frequent primary. The duration of symptoms before patients received treatment varied from one day to 6 months. Brain scans were reported as abnormal (positive for metastases) in the majority of patients prior to treatment. The method employed in treatment consisted of exposing the whole brain through 2 parallel opposing fields (10 × 15 cm in size) to 1,000 rads in a single exposure with cobalt-60. Of 54 patients treated, 40 are dead and 14 are alive. There was complete follow-up on all patients. Sixty-five percent of the patients showed significant improvement following treatment. Three patients died within 48 hours of treatment. The mean life survival was 5.6 months. Routine use of steroids in association with irradiation was employed originally and later discontinued. The role of steroids and irradiation on brain edema associated with tumors is discussed.