Long-term survival in patients with non-small cell lung cancer and synchronous brain metastasis treated with whole-brain radiotherapy and thoracic chemoradiation

Radiation Oncology

Jaime de la Garza²  Saé Muñiz-Hernández³  Diego G Zavala³  María D de la Mata⁴  Mónika Blake-Cerda⁴  Jesús Zamora⁴  Cynthia Villarreal-Garza³  Oscar Arrieta¹ 

[1] Facultad de Medicina, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico;Clinic of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico;Experimental Oncology Laboratory, INCan, Mexico City, Mexico;Radio-Oncology Department, INCan, Mexico City, Mexico

关键词: survival;    chemoradiotherapy;    brain metastases;    NSCLC;   

Others  :  1160932
DOI  :  10.1186/1748-717X-6-166

 received in 2011-07-29, accepted in 2011-11-25,  发布年份 2011

【 摘 要 】

Background

Brain metastases occur in 30-50% of Non-small cell lung cancer (NSCLC) patients and confer a worse prognosis and quality of life. These patients are usually treated with Whole-brain radiotherapy (WBRT) followed by systemic therapy. Few studies have evaluated the role of chemoradiotherapy to the primary tumor after WBRT as definitive treatment in the management of these patients.

Methods

We reviewed the outcome of 30 patients with primary NSCLC and brain metastasis at diagnosis without evidence of other metastatic sites. Patients were treated with WBRT and after induction chemotherapy with paclitaxel and cisplatin for two cycles. In the absence of progression, concurrent chemoradiotherapy for the primary tumor with weekly paclitaxel and carboplatin was indicated, with a total effective dose of 60 Gy. If disease progression was ruled out, four chemotherapy cycles followed.

Results

Median Progression-free survival (PFS) and Overall survival (OS) were 8.43 ± 1.5 and 31.8 ± 15.8 months, respectively. PFS was 39.5% at 1 year and 24.7% at 2 years. The 1- and 2-year OS rates were 71.1 and 60.2%, respectively. Three-year OS was significantly superior for patients with N0-N1 stage disease vs. N2-N3 (60 vs. 24%, respectively; Response rate [RR], 0.03; p= 0.038).

Conclusions

Patients with NSCLC and brain metastasis might benefit from treatment with WBRT and concurrent thoracic chemoradiotherapy. The subgroup of N0-N1 patients appears to achieve the greatest benefit. The result of this study warrants a prospective trial to confirm the benefit of this treatment.

【 授权许可】

   
2011 Arrieta et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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