Clinical evaluation of simultaneous integrated boost in brain metastasis patients with helical intensity modulated radiotherapy

Brain metastasis is (BM) a signi icant clinical problem in cancer management which occurs on 20 to 45% of all cancer patients (1-2). The primary cancer sites which BM mostly originate from are lung (40-50%) and breast cancer (20-30%) (3). 20-30% of patients with BM have more than 3 metastases, while 70-80% of patients have 1-3 BM (4). The median survival has been observed to be 4-7 months with various fractionation and dose regimens of whole brain radiotherapy (WBRT) (5-6). The treatment of brain metastases is dif icult because of the side effects caused by radiotherapy (RT) and chemotherapy (CT). There is still no signi icant improvement on survival rates despite new treatment schedules (7). Median survival has been observed to be between 2-13 months in new BM treatment schedules (5-6). The primary treatment schedule employed for patients with multiple BM is WBRT either with or without steroids. Surgery and/or radiosurgery, either with or without WBRT was employed for patients with between 1 4 BM sites. With this local and distant brain failure was observed in a substantial number of patients. Two prospective phase III trials have shown a 1-year local and/or distant brain failure ABSTRACT