Abstract
Non-small-cell lung cancer (NSCLC) patients who experience brain metastases are usually associated with poor prognostic outcomes. This retrospective study proposed to assess whether bevacizumab or gefitinib can be used to improve the effectiveness of whole brain radiotherapy (WBRT) in managing patients with brain metastases. A total of 218 NSCLC patients with multiple brain metastases were retrospectively included in this study and were randomly allocated to bevacizumab-gefitinib-WBRT group (n=76), gefitinib-WBRT group (n=77) and WBRT group (n=75). Then, tumor responses were evaluated every 2 months based on Response Evaluation Criteria in Solid Tumors version 1.0. Karnofsky performance status and neurologic examination were documented every 6 months after the treatment. Compared to the standard WBRT, bevacizumab and gefitinib could significantly enhance response rate (RR) and disease control rate (DCR) of WBRT (P<0.001). At the same time, RR and DCR of patients who received bevacizumab-gefitinib-WBRT were higher than those who received gefitinib-WBRT. The overall survival (OS) rates and progression-free survival (PFS) rates also differed significantly among the bevacizumab-gefitinib-WBRT (48.6 and 29.8%), gefitinib-WBRT (36.7 and 29.6%) and WBRT (9.8 and 14.6%) groups (P<0.05). Although bevacizumab-gefitinib-WBRT was slightly more toxic than gefitinib-WBRT, the toxicity was tolerable. As suggested by prolonged PFS and OS status, bevacizumab substantially improved the overall efficacy of WBRT in the management of patients with NSCLC.
Highlights
Lung cancer is a major cause for cancer-related deaths and up to 222,520 new cases were diagnosed in the US in 2010 [1]
The patients were included if: 1) their primary lesions were histologically confirmed as non-small cell lung cancer (NSCLC); 2) their brain metastases (BM) was diagnosed by magnetic resonance imaging, and at least one measurable intracranial metastases could be utilized to assess treatment efficacy; 3) they were treated with whole-brain radiation therapy (WBRT) due to inability and rejection to receive surgical treatments, and their lesions displayed no acute bleeding; 4) their hemogram had no obvious abnormity; 5) their Karnofsky performance status (KPS) scoring achieved h 60 scores; and 6) their medical records were complete
Surgical excision has been considered an effective approach for managing BM resulting from NSCLC, the median survival time for patients who experience such a disease progression is less than 3 months [24]
Summary
Lung cancer is a major cause for cancer-related deaths and up to 222,520 new cases were diagnosed in the US in 2010 [1]. Almost 85% of lung cancer cases are classified as non-small cell lung cancer (NSCLC), which includes both non-squamous carcinoma and squamous cell carcinoma [2]. Substantial improvement in treatments has been made, NSCLC prognosis remains unfavorable since it is an uncontrolled systemic disease. About 20 to 40% NSCLC patients may end up with brain metastases (BM) as disease progresses [3]. Conventional treatments for brain metastases resulting from NSCLC include whole-brain radiation therapy (WBRT), surgical resection, stereotactic radiosurgery or the combination of these approaches [5]
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