Fractionated external beam radiotherapy of skull base metastases with cranial nerve involvement

Background and purpose Skull base metastases frequently appear in a late stage of various tumor entities and cause pain and neurological disorders which strongly impair patient quality of life. This study retrospectively analyzed fractionated external beam radiotherapy (EBRT) as a palliative treatme...

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Published in:	Strahlentherapie und Onkologie Vol. 190; no. 2; pp. 199 - 203
Main Authors:	Dröge, L.H., Hinsche, T., Canis, M., Alt-Epping, B., Hess, C.F., Wolff, H.A.
Format:	Journal Article
Language:	English
Published:	Berlin/Heidelberg Springer Berlin Heidelberg 01-02-2014 Springer Nature B.V
Subjects:	Aged Aged, 80 and over Cranial Nerves - pathology Cranial Nerves - radiation effects Dose Fractionation Female Humans Male Medicine Medicine & Public Health Middle Aged Neoplasm Invasiveness Neurologic Examination - radiation effects Oncology Original Article Radiation Injuries - etiology Radiotherapy Radiotherapy Dosage Skull Base Neoplasms - pathology Skull Base Neoplasms - radiotherapy Skull Base Neoplasms - secondary Treatment Outcome Retrospektivstudie Toxizität Lebensqualität Toxicity Outcome Retrospective study Palliative treatment Quality of life Palliativbehandlung
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Summary:	Background and purpose Skull base metastases frequently appear in a late stage of various tumor entities and cause pain and neurological disorders which strongly impair patient quality of life. This study retrospectively analyzed fractionated external beam radiotherapy (EBRT) as a palliative treatment approach with special respect to neurological outcome, feasibility and acute toxicity. Patients and methods A total of 30 patients with skull base metastases and cranial nerve disorders underwent EBRT with a mean total dose of 31.6 Gy. Neurological status was assessed before radiotherapy, during radiotherapy and 2 weeks afterwards categorizing orbital, parasellar, middle fossa, jugular foramen and occipital condyle involvement and associated clinical syndromes. Neurological outcome was scored as persistence of symptoms, partial response, good response and complete remission. Treatment-related toxicity and overall survival were assessed. Results Before EBRT 37 skull base involvement syndromes were determined with 4 patients showing more than 1 syndrome. Of the patients 81.1 % responded to radiotherapy with 10.8 % in complete remission, 48.6 % with good response and 21.6 % with partial response. Grade 1 toxicity of the skin occurred in two patients and grade 1 hematological toxicity in 1 patient under concurrent chemoradiotherapy. Median overall survival was 3.9 months with a median follow-up of 45 months. Conclusion The use of EBRT for skull base metastases with symptomatic involvement of cranial nerves is marked by good therapeutic success in terms of neurological outcome, high feasibility and low toxicity rates. These findings underline EBRT as the standard therapeutic approach in the palliative setting.
ISSN:	0179-7158 1439-099X
DOI:	10.1007/s00066-013-0460-9