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

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2011

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Arrieta Oscar , Villarreal-Garza Cynthia , Zamora Jesús , Blake-Cerda Mónika , Muñiz-Hernández Saé , Zavala , De

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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.

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biomed

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01 janvier 2011

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English

Arrietaet al.Radiation Oncology2011,6:166 http://www.rojournal.com/content/6/1/166

R E S E A R C H

Open Access

Longterm survival in patients with nonsmall cell lung cancer and synchronous brain metastasis treated with wholebrain radiotherapy and thoracic chemoradiation 1,2,3* 2 1,4 4 1,4 Oscar Arrieta , Cynthia VillarrealGarza , Jesús Zamora , Mónika BlakeCerda , María D de la Mata , 2 2 1 Diego G Zavala , Saé MuñizHernández and Jaime de la Garza

Abstract 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. Keywords:NSCLC, brain metastases, chemoradiotherapy, survival

Introduction Brain metastases occur in 3050% of patients with Non smallcell lung cancer (NSCLC) and confer upon the patient a worse prognosis and quality of life [16]. Med ian survival of patients who receive supportive care and are treated only with corticosteroids is approximately 1 2 months [2]. Primary approaches to the treatment of brain metastases include Wholebrain radiation therapy (WBRT), surgery, stereotactic radiosurgery, or a

* Correspondence: ogar@servidor.unam.mx 1 Clinic of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico Full list of author information is available at the end of the article

combination, which have achieved a median survival time that ranges from 6.510 months [711]. As improvements are made in the management of brain metastases, the question arises on how to manage patients with NSCLC who have solely stable brain meta static disease and on whether treatment should be con sidered for the primary lung lesion. Longterm survival has been achieved in some patients who have undergone either cranial surgery or radiotherapy and aggressive thoracic management with lung tumor resection, with studies reporting 5year survival rates between 10 and 20% [1216]. Few studies have evaluated the role of thoracic radiation or chemoradiotherapy as definitive

© 2011 Arrieta et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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