Definitive Chemoradiation Therapy Following Surgical Resection or Radiosurgery Plus Whole-Brain Radiation Therapy in Non-Small Cell Lung Cancer Patients With Synchronous Solitary Brain Metastasis: A Curative Approach

• Published in: International journal of radiation oncology, biology, physics Vol. 88; no. 4; pp. 885 - 891
• Main Authors: Parlak, Cem, MD, Mertsoylu, Hüseyin, MD, Güler, Ozan Cem, MD, Onal, Cem, MD, Topkan, Erkan, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15-03-2014
• Subjects: Adult; Aged; Analysis of Variance; BRAIN; Brain Neoplasms - mortality; Brain Neoplasms - secondary; Brain Neoplasms - therapy; Carcinoma, Non-Small-Cell Lung - mortality; Carcinoma, Non-Small-Cell Lung - pathology; Carcinoma, Non-Small-Cell Lung - secondary; Carcinoma, Non-Small-Cell Lung - therapy; Chemoradiotherapy - adverse effects; Chemoradiotherapy - methods; CHEMOTHERAPY; Cisplatin - administration & dosage; Combined Modality Therapy - adverse effects; Combined Modality Therapy - methods; Cranial Irradiation - adverse effects; Cranial Irradiation - methods; Disease-Free Survival; Female; Hematology, Oncology and Palliative Medicine; Humans; Lung Neoplasms - mortality; Lung Neoplasms - pathology; Lung Neoplasms - therapy; LUNGS; Male; METASTASES; Middle Aged; MULTIVARIATE ANALYSIS; Neoplasm Staging - methods; NEOPLASMS; PATIENTS; POSITRON COMPUTED TOMOGRAPHY; Radiology; RADIOLOGY AND NUCLEAR MEDICINE; Radiosurgery - adverse effects; Radiosurgery - methods; RADIOTHERAPY; Retrospective Studies; SURGERY
• ISSN: 0360-3016; 1879-355X
• DOI: 10.1016/j.ijrobp.2013.12.017

Purpose/Objectives The aim of this study was to evaluate the impact of definitive thoracic chemoradiation therapy following surgery or stereotactic radiosurgery (SRS) and whole-brain radiation therapy (WBRT) on the outcomes of patients with non-small cell lung cancer (NSCLC) with synchronous solitary brain metastasis (SSBM). Methods and Materials A total of 63 NSCLC patients with SSBM were retrospectively evaluated. Patients were staged using positron emission tomography-computed tomography in addition to conventional staging tools. Thoracic radiation therapy (TRT) with a total dose of 66 Gy in 2 Gy fractions was delivered along with 2 cycles of cisplatin-based chemotherapy following either surgery plus 30 Gy of WBRT (n=33) or SRS plus 30 Gy of WBRT (n=30) for BM. Results Overall, the treatment was well tolerated. All patients received planned TRT, and 57 patients (90.5%) were also able to receive 2 cycles of chemotherapy. At a median follow-up of 25.3 months (7.1-52.1 months), the median months of overall, locoregional progression-free, neurological progression-free, and progression-free survival were 28.6, 17.7, 26.4, and 14.6, respectively. Both univariate and multivariate analyses revealed that patients with a T1-T2 thoracic disease burden ( P =.001), a nodal stage of N0-N1 ( P =.003), and no weight loss ( P =.008) exhibited superior survival. Conclusions In the present series, surgical and radiosurgical treatments directed toward SSBM in NSCLC patients were equally effective. The similarities between the present survival outcomes and those reported in other studies for locally advanced NSCLC patients indicate the potentially curative role of definitive chemoradiation therapy for highly selected patients with SSBM.