Factors Affecting the Risk of Brain Metastases After Definitive Chemoradiation for Locally Advanced Non–Small-Cell Lung Carcinoma

• Published in: Journal of clinical oncology Vol. 19; no. 5; pp. 1344 - 1349
• Main Authors: ROBNETT, Theodore J, MACHTAY, Mitchell, STEVENSON, James P, ALGAZY, Kenneth M, HAHN, Stephen M
• Format: Journal Article
• Language: English
• Published: Baltimore, MD American Society of Clinical Oncology 01.03.2001; Lippincott Williams & Wilkins
• Subjects: Adult; Aged; Antineoplastic agents; Biological and medical sciences; Brain Neoplasms - etiology; Brain Neoplasms - radiotherapy; Brain Neoplasms - secondary; Carcinoma, Non-Small-Cell Lung - drug therapy; Carcinoma, Non-Small-Cell Lung - radiotherapy; Carcinoma, Non-Small-Cell Lung - secondary; Combined Modality Therapy; Combined treatments (chemotherapy of immunotherapy associated with an other treatment); Cranial Irradiation; Female; Humans; Lung Neoplasms - drug therapy; Lung Neoplasms - pathology; Lung Neoplasms - radiotherapy; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Prognosis; Retrospective Studies; Risk Factors; Antineoplastic agent; Human; Lung disease; Intracranial; Nervous system diseases; Prognosis; Respiratory disease; Malignant tumor; Metastasis; Radiotherapy; Bronchopulmonary; Cerebral disorder; Chemotherapy; Central nervous system disease; Risk factor; Bronchus disease; Advanced stage; Combined treatment; Small cell carcinoma
• DOI: 10.1200/jco.2001.19.5.1344
• ISSN: 0732-183X

As therapy for locally advanced non-small-cell lung carcinoma (NSCLC) improves, brain metastases (BM) may become a greater problem. We analyzed our chemoradiation experience for patients at highest risk for the brain as the first failure site. Records for 150 consecutive patients with stage II/III NSCLC treated definitively with chemoradiation from June 1992 to June 1998 at the University of Pennsylvania were reviewed. Most patients (89%) received cisplatin, paclitaxel, or both. All had negative brain imaging before treatment. Posttreatment brain imaging was performed for suspicious symptoms. Incidence of BM was examined as a function of age, sex, histology, stage, performance status, weight loss, tumor location, surgery, radiation dose, initial radiation field, chemotherapy regimen, and chemotherapy timing. Crude and 2-year actuarial rates of BM were 19% and 30%, respectively. Among pretreatment parameters, stage IIIB was associated with a higher risk of BM (P <.04) versus stage II/IIIA. Histology alone was not significant (P <.12), although patients with IIIB nonsquamous tumors had an exceptionally high 2-year BM rate of 42% (P <.01 v all others). Examining treatment-related parameters, crude and 2-year actuarial risk of BM were 27% and 39%, respectively, in patients receiving chemotherapy before radiotherapy and 15% and 20%, respectively, when radiotherapy was not delayed (P <.05). On multivariate analysis, timing of chemotherapy (P <.01) and stage IIIA versus IIIB (P <.01) remained significant. Patients with later stage, nonsquamous NSCLC, particularly those receiving induction chemotherapy, have sufficiently common BM rates to justify future trials including prophylactic cranial irradiation.