Impact Of Whole Brain Radiotherapy Research Articles

Impact of Whole Brain Radiotherapy on Leptomeningeal Metastasis from Non-Small Cell Lung Cancer in Targeted Therapy Era

Impact of Whole Brain Radiotherapy on Leptomeningeal Metastasis from Non-Small Cell Lung Cancer in Targeted Therapy Era

CMET-40. IMPACT OF WHOLE BRAIN RADIOTHERAPY ON LEPTOMENINGEAL METASTASIS FROM NON-SMALL CELL LUNG CANCER

Abstract BACKGROUND Leptomeningeal metastasis (LM) is a detrimental complication of patients with non-small cell lung cancer (NSCLC) and its incidence has increased due to recent improvements in survival. The aim of this study was to assess the impact of whole brain radiotherapy (WBRT), chemotherapy and epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) on survival. METHODS Seventy-four consecutive patients diagnosed with LM from NSCLC between 2009 and 2018 in Sanjiu Brain Hospital were retrospectively reviewed. Survival was assessed by Kaplan-Meier analyses. RESULTS The median age was 54.5 (range 30–76) years. LM were diagnosed by MRI (36/74), cytology (4/74), or both (34/74). Eighteen patients (24.3%) were diagnosed at the initial presentation of lung cancer. Forty-seven (63.5%) patients harboring EGFR positive mutation while other twenty-seven patients (36.5%) were EGFR wild type. The median overall survival from diagnosis of LM was 8.1 months (95% confidence interval: 5.2 to 11.0). Patients who received EGFR-TKIs after LM had longer survival than those who did not (10.5 vs. 4.4 months, p＜0.001). No significant differences in survival were seen between patients who were treated with WBRT and those without, whether in EGFR mutation positive patients (11.6 vs. 15.0 months, p=0.353), or in EGFR wild type ones (5.1 vs. 3.3 months, p=0.116). Similarly, intravenous chemotherapy after LM had no impact on overall survival (7.5 vs. 8.1 months, p=0.9). CONCLUSION Median overall survival was higher than historical experience in our retrospective analysis. Survival was not improved by WBRT or intravenous chemotherapy. EGFR-TKIs could prolong survival of patients with LM from NSCLC.

Neuropsychological functioning of children treated for acute lymphoblastic leukemia: impact of whole brain radiation therapy.

To provide one of the first prospective reports examining neuropsychological outcomes for children treated with 1800 cGy whole brain radiotherapy (WBRT) and prophylactic chemotherapy versus prophylactic chemotherapy alone for acute lymphoblastic leukemia (ALL). Acute and long-term neuropsychological toxicities associated with WBRT are compared. This multisite study included 188 children, ages 4-21 years at enrollment, who were assessed with standardized neuropsychological tests at 9, 21, and 48 months after diagnosis with intermediate risk ALL. All participating children were receiving treatment on a parent study CCG105. Verbal intelligence (VIQ) scores for children receiving WBRT was significantly lower than VIQ for prophylactic chemotherapy at the 48-month time point (p < 0.05). A significant cross-level interaction between time since diagnosis and treatment condition was observed (p < 0.05). WBRT did not result in differences in PIQ; both groups of children demonstrated comparable increases in PIQ. Neuropsychological findings at 48 months after diagnosis indicated diminished performance in neuromotor, visual-motor coordination, and executive functioning for children receiving WBRT. Academic achievement was unaffected by WBRT at 4 years after diagnosis. The measurement of verbal and performance IQ as a primary endpoint in ALL clinical trials is critical to characterizing neuropsychological late effects. A trajectory of decline in neuropsychological functioning, specifically verbal IQ, was observed. Missing data within the trial occurred at random and did not impact results observed. The impact of WBRT becomes evident at 48 months after diagnosis, suggesting the need for long-term follow-up beyond the time frame typically used in Phase III trials.

Leptomeningeal Metastasis from Non-small Cell Lung Cancer: Survival and the Impact of Whole Brain Radiotherapy

Leptomeningeal metastasis (LM), or leptomeningeal carcinomatosis, is a devastating complication of non-small cell lung cancer (NSCLC), and the optimal therapeutic approach remains challenging. A retrospective review was carried out to assess the impact of whole brain radiotherapy (WBRT), intrathecal therapy (IT), and epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) on outcomes. Patients with newly diagnosed LM from NSCLC from January 2002 to December 2009 were identified through institutional databases and medical records reviewed. Survival was assessed by Kaplan-Meier and landmark analyses by administered treatment to minimize selection bias. We identified 125 patients (45 men, 80 women) with LM from NSCLC, median age 59 years (range, 28-87 years). Almost all (123 [98%]) patients have died and median overall survival was 3.0 months (95% confidence interval, 2.0-4.0). No differences in survival were seen between patients who were treated with WBRT (n =46) and those who were not (n =59, p =0.84) in a landmark analysis. In the seven patients selected to receive IT chemotherapy, median survival was 18 months (range, 5-33 months) and appeared superior to those not selected for this treatment (p =0.001) in a landmark analysis. The median survival of the nine patients with known EGFR mutations (all of whom received TKIs at some point) was 14 months (range, 1-28 months). This retrospective study, the largest published series, demonstrates the poor survival of LM from NSCLC. In this study, survival was not improved by WBRT. The survival of patients selected for IT chemotherapy and those with EGFR mutations treated with TKIs highlights the importance of developing novel agents.