Primary Chemotherapy for Newly Diagnosed Nonsmall Cell Lung Cancer Patients With Synchronous Brain Metastases Compared With Whole-Brain Radiotherapy Administered First : Result of a Randomized Pilot Study

• Published in: Cancer Vol. 113; no. 1; pp. 143 - 149
• Main Authors: DAE HO LEE, HAN, Ji-Youn, HEUNG TAE KIM, SUNG JIN YOON, HONG RYULL PYO, KWAN HO CHO, SHIN, Sang-Hoon, YOO, Heon, LEE, Seung-Hoon, JIN SOO LEE
• Format: Journal Article
• Language: English
• Published: New York, NY Wiley-Liss 01.07.2008
• Subjects: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Brain Neoplasms - radiotherapy; Brain Neoplasms - secondary; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - pathology; Combined Modality Therapy; Cranial Irradiation; Feasibility Studies; Female; Humans; Lung Neoplasms - drug therapy; Male; Medical sciences; Middle Aged; Pilot Projects; Pneumology; Quality of Life; Survival Analysis; Tumors; Tumors of the respiratory system and mediastinum; Brain cancer; Lung cancer; Central nervous system; Early stage; non-small cell lung carcinoma; Encephalon; Randomization; Cancerology; Primary; Bronchus disease; Human; Lung disease; Nervous system diseases; Respiratory disease; nonsmall cell lung cancer; Malignant tumor; Radiotherapy; Cerebral metastasis; Cerebral disorder; whole brain radiotherapy; Chemotherapy; Treatment; primary chemotherapy; Central nervous system disease; brain metastasis; Comparative study; Cancer
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.23526

This randomized pilot trial investigated whether primary chemotherapy was feasible in terms of efficacy, survival, toxicity profile, and quality of life compared with whole-brain radiotherapy (WBRT) given first in chemotherapy-naive patients nonsmall cell lung cancer (NSCLC) with synchronous brain metastasis when neurologic symptoms or signs are absent or controlled by supportive care. After stratification by Eastern Cooperative Oncology Group performance status (ECOG PS) (0-1 vs 2), the number of intracranial metastases (<3 vs 3< or =), and the presence of extrathoracic extracranial metastasis, eligible patients were randomized to the primary chemotherapy arm or the WBRT-first arm. World Health Organization (WHO) response criteria, National Cancer Institute Common Toxicity Criteria (NCI-CTC; version 2.0), and the European Organization for Research and Treatment of Cancer (EORTC) C-30/LC-13 questionnaire were used. A total of 48 patients were enrolled between August 2002 and November 2005. The response rate of chemotherapy and survival outcomes in the primary chemotherapy arm were not statistically different from those in the WBRT-first arm (overall response rate, 28.0% vs 39.1%; progression-free survival, 3.6 months vs 4.4 months; overall survival, 9.1 months vs 9.9 months). There was close correlation noted between intracranial and extracranial tumor responses (k = 0.82). However, in the WBRT-first arm, grade 3 of 4 neutropenia was more frequent (79% vs 40%) during chemotherapy and 4 patients (17.4%) did not receive further chemotherapy because of early death or poor performance after WBRT. Cognitive function appeared to deteriorate during primary chemotherapy, but was also found to deteriorate after WBRT. Primary chemotherapy is more feasible and can be an appropriate option for patients with synchronous brain metastasis when neurologic symptoms or signs are absent or controlled. The role and timing of WBRT should be defined in further studies in this clinical setting.