Tolerance of brain to multiple courses of radiation therapy. I. Clinical experiences

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Abstract
Patients with recurrent brain tumors years after initial radiation therapy pose a difficult management decision. Should retreatment be performed with irradiation, which carries a risk of necrosis, or should retreatment be with less effective agents but without unnecessary risks? The results of retreatment of 32 patients, are presented. Clinical improvement was seen in all retreated patients. The median survival was 36 mo. after completion of the 2nd course of irradiation. Eight patients (25%) were alive, free of disease, from 22-315 mo. after retreatment. Of the 11 patients alive at the time of analysis, 8 were experiencing productive lives; 3 were suffering from severe neurological damage. Evidence of brain necrosis was observed in 2 patients (6%); only 10/21 patients underwent autopsy examinations. Reirradiation of patients with late recurrences of brain tumors may offer neurological improvement and prolonged survival without excessive risk of necrosis.