The efficacy and roles of combining temozolomide with whole brain radiotherapy in protection neurocognitive function and improvement quality of life of non-small-cell lung cancer patients with brain metastases

BMC Cancer

Research Article

Zhenghua Fei¹  Xiance Jin¹  Shaoran Fei¹  Zhen Zheng¹  Baochai Lin¹  Hanbin Chen¹  Xia Deng¹  Huafang Su¹  Lihao Zhao¹  Cong-Ying Xie² 

[1] Department of Radiotherapy and Chemotherapy, the First Affiliated Hospital of Wenzhou Medical University, No.2 Fuxue Lane, 325000, Wenzhou, China;Zhejiang Provincial Key Laboratory of Aging and Neurological Disorder Research, 325000, Wenzhou, China;Department of Radiotherapy and Chemotherapy, the First Affiliated Hospital of Wenzhou Medical University, No.2 Fuxue Lane, 325000, Wenzhou, China;

关键词: Temozolomide;    Non-small-cell lung cancer;    Brain metastases;    Whole brain radiotherapy;    Neurocognitive function;    Quality of life;   

DOI  :  10.1186/s12885-016-3017-3

 received in 2016-05-18, accepted in 2016-12-16,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundBrain metastasis (BM) is a poor prognostic factor for non-small-cell lung cancer (NSCLC). The efficacy and roles of combining temozolomide (TMZ) with whole brain radiotherapy (WBRT) in protection neurocognitive function (NCF) and improvement quality of life (QOL) were investigated and compared with WBRT alone in the treatment of NSCLC patients with BM.MethodsA total of 238 NSCLC patients with BM were reviewed and categorized into WBRT plus TMZ (RCT) arm and WBRT alone (RT), respectively. The efficacy was evaluated with Pearson chi-square or Fisher’s exact tests, Log-rank test and Cox proportional hazards model. NCF was assessed by using revised Hopkins Verbal Learning Test (HVLT-R), Controlled Oral Word Association (COWA) test and Trail-making Test (TMT). QOL was assessed by the Functional Assessment of Cancer Treatment-Lung (FACT-L) Chinese version 4.0 questionnaire.ResultsThe average intracranial objective response (ORR) and disease control rate (DCR) for all the patients were 26.9 and 95.8%, respectively. The intracranial ORR and DCR for RCT and RT arm were 34.9% vs. 20.2% (p = 0.01) and 98.4% vs. 92.7% (p = 0.03), respectively. The median intracranial progression-free survival (PFS) and overall survival (OS) of NSCLC patients with BM were 5.2 and 7.3 months, respectively. The median PFS of RCT arm was significantly longer than that of RT arm (5.9 vs. 4.9 months, p = 0.002). The median OS of the RCT arm was also slightly longer than that of the RT arm (8.5 vs. 5.9 months), but without statistical significance (p = 0.11). Multivariate analysis indicated that TMZ was a significant factor for PFS. Statistically significant differences on NCF and QOL were observed between CRT and RT arms at 5 months. RCT showed a trend of toxicities increase compared with RT, however, the toxicities were tolerable and manageable.ConclusionsAdding TMZ to WBRT in the treatment of NSCLC patients with BM could improve the intracranial ORR, DCR, and median PFS compared with WBRT alone. Although no remarkable difference on median OS was found, adding TMZ could prevent NCF and QOL from worsening. The side effects increased by adding TMZ, but the difference was not statistical significance and toxicities were well tolerated.

【 授权许可】

CC BY   
© The Author(s). 2017