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

Oscar Arrieta,Diego G Zavala,María D De La Mata,Jesús Zamora,Jaime De La Garza,Saé Muñiz-Hernández,Cynthia Villarreal-Garza,Mónika Blake-Cerda

doi:10.1186/1748-717x-6-166

Abstract

BackgroundBrain 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.MethodsWe 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.ResultsMedian 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).ConclusionsPatients 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.

Highlights

Brain metastases occur in 30-50% of patients with Nonsmall-cell lung cancer (NSCLC) and confer upon the patient a worse prognosis and quality of life [1,2,3,4,5,6]
As improvements are made in the management of brain metastases, the question arises on how to manage patients with Non-small cell lung cancer (NSCLC) who have solely stable brain metastatic disease and on whether treatment should be considered for the primary lung lesion
In an effort to clarify such conflicting data and in order to identify patients who may benefit from aggressive management, we reviewed the outcome of 30 patients with either unresectable single or multiple brain metastases treated with Whole-brain radiotherapy (WBRT), who were managed subsequently with definitive thoracic chemoradiotherapy

Summary

Introduction

Brain metastases occur in 30-50% of patients with Nonsmall-cell lung cancer (NSCLC) and confer upon the patient a worse prognosis and quality of life [1,2,3,4,5,6]. Few studies have evaluated the role of thoracic radiation or chemoradiotherapy as definitive treatment in the management of patients with NCSLC and synchronous solitary brain metastasis, and some of these have shown promising results [17,18]. Despite these findings, the majority of patients are only offered chemotherapy or radiation therapy in a palliative manner [18]. 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

Results

Conclusion