Cerebellar re-irradiation after whole brain radiotherapy significant symptom relief with minimal toxicity in metastatic brain patients
Abstract Whole-brain radiotherapy (WBRT) remains a standard treatment for extensive brain metastases, providing symptom relief and improved progression-free survival (PFS). Re-irradiation is often necessary for recurrent disease, particularly in the cerebellum, which accounts for 10–20% of cases. Ce...
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Nature Portfolio
2025-02-01
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| author | Ory Haisraely Marcia Jaffe Yaacov Richard Lawerence Alicia Talianksy Alicia Taliansky |
| author_facet | Ory Haisraely Marcia Jaffe Yaacov Richard Lawerence Alicia Talianksy Alicia Taliansky |
| author_sort | Ory Haisraely |
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| description | Abstract Whole-brain radiotherapy (WBRT) remains a standard treatment for extensive brain metastases, providing symptom relief and improved progression-free survival (PFS). Re-irradiation is often necessary for recurrent disease, particularly in the cerebellum, which accounts for 10–20% of cases. Cerebellar metastases are associated with distinct symptoms and poorer prognoses compared to supratentorial lesions. This study evaluates the outcomes of cerebellar-only re-irradiation for brain metastases, with or without stereotactic radiosurgery (SRS) for supratentorial lesions. A retrospective analysis of 56 patients treated between 2017 and 2023 was conducted. Patients received cerebellar-only re-irradiation after WBRT. Symptom improvement was assessed three months post-treatment. Statistical analyses included t-tests, Mann-Whitney U tests, and multivariable logistic regression. The cohort’s median age was 53 years, with breast cancer being the most prevalent histology (71%). Symptom improvement occurred in 75% of patients, with relief rates of 84.6% for nausea, 80% for headache, and 58.3% for dizziness. Dexamethasone use decreased in 76.3% of cases. Median PFS was 39.2%, with a six-month overall survival of 50%. Only 1.7% of patients developed symptomatic radiation necrosis. Factors associated with symptom improvement included younger age, extended intervals between WBRT and re-irradiation, and higher equivalent dose in 2 Gy fractions (EQD2). Cerebellar-only re-irradiation is an effective, low-toxicity option for recurrent cerebellar metastases. This approach warrants further validation in prospective studies, particularly in comparison to SRS. |
| format | Article |
| id | doaj-art-de979272f555460f8751d3c31bf1bdb0 |
| institution | Kabale University |
| issn | 2045-2322 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | Nature Portfolio |
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| spelling | doaj-art-de979272f555460f8751d3c31bf1bdb02025-02-09T12:32:42ZengNature PortfolioScientific Reports2045-23222025-02-011511910.1038/s41598-025-88652-7Cerebellar re-irradiation after whole brain radiotherapy significant symptom relief with minimal toxicity in metastatic brain patientsOry Haisraely0Marcia Jaffe1Yaacov Richard Lawerence2Alicia Talianksy3Alicia Taliansky4Sheba Medical CenterSheba Medical CenterSheba Medical CenterSheba Medical CenterSheba Medical CenterAbstract Whole-brain radiotherapy (WBRT) remains a standard treatment for extensive brain metastases, providing symptom relief and improved progression-free survival (PFS). Re-irradiation is often necessary for recurrent disease, particularly in the cerebellum, which accounts for 10–20% of cases. Cerebellar metastases are associated with distinct symptoms and poorer prognoses compared to supratentorial lesions. This study evaluates the outcomes of cerebellar-only re-irradiation for brain metastases, with or without stereotactic radiosurgery (SRS) for supratentorial lesions. A retrospective analysis of 56 patients treated between 2017 and 2023 was conducted. Patients received cerebellar-only re-irradiation after WBRT. Symptom improvement was assessed three months post-treatment. Statistical analyses included t-tests, Mann-Whitney U tests, and multivariable logistic regression. The cohort’s median age was 53 years, with breast cancer being the most prevalent histology (71%). Symptom improvement occurred in 75% of patients, with relief rates of 84.6% for nausea, 80% for headache, and 58.3% for dizziness. Dexamethasone use decreased in 76.3% of cases. Median PFS was 39.2%, with a six-month overall survival of 50%. Only 1.7% of patients developed symptomatic radiation necrosis. Factors associated with symptom improvement included younger age, extended intervals between WBRT and re-irradiation, and higher equivalent dose in 2 Gy fractions (EQD2). Cerebellar-only re-irradiation is an effective, low-toxicity option for recurrent cerebellar metastases. This approach warrants further validation in prospective studies, particularly in comparison to SRS.https://doi.org/10.1038/s41598-025-88652-7Brain metastasesRadiotherapyCerebellum |
| spellingShingle | Ory Haisraely Marcia Jaffe Yaacov Richard Lawerence Alicia Talianksy Alicia Taliansky Cerebellar re-irradiation after whole brain radiotherapy significant symptom relief with minimal toxicity in metastatic brain patients Scientific Reports Brain metastases Radiotherapy Cerebellum |
| title | Cerebellar re-irradiation after whole brain radiotherapy significant symptom relief with minimal toxicity in metastatic brain patients |
| title_full | Cerebellar re-irradiation after whole brain radiotherapy significant symptom relief with minimal toxicity in metastatic brain patients |
| title_fullStr | Cerebellar re-irradiation after whole brain radiotherapy significant symptom relief with minimal toxicity in metastatic brain patients |
| title_full_unstemmed | Cerebellar re-irradiation after whole brain radiotherapy significant symptom relief with minimal toxicity in metastatic brain patients |
| title_short | Cerebellar re-irradiation after whole brain radiotherapy significant symptom relief with minimal toxicity in metastatic brain patients |
| title_sort | cerebellar re irradiation after whole brain radiotherapy significant symptom relief with minimal toxicity in metastatic brain patients |
| topic | Brain metastases Radiotherapy Cerebellum |
| url | https://doi.org/10.1038/s41598-025-88652-7 |
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