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Prognostic Factors in Patients with Non-small Cell Lung Carcinoma and Brain Metastases: a Malaysian Perspective

  • Tang, Weng Heng (Clinical Oncology Unit, University of Malaya Medical Centre) ;
  • Alip, Adlinda (Clinical Oncology Unit, University of Malaya Medical Centre) ;
  • Saad, Marniza (Clinical Oncology Unit, University of Malaya Medical Centre) ;
  • Phua, Vincent Chee Ee (Clinical Oncology Unit, University of Malaya Medical Centre) ;
  • Chandran, Hari (Neurosurgical Unit, University of Malaya Medical Centre) ;
  • Tan, Yi Hang (Beacon Cancer Hospital) ;
  • Tan, Yan Yin (Beacon Cancer Hospital) ;
  • Kua, Voon Fong (Beacon Cancer Hospital) ;
  • Wahid, Mohamed Ibrahim (Beacon Cancer Hospital) ;
  • Tho, Lye Mun (Beacon Cancer Hospital)
  • Published : 2015.03.18

Abstract

Background: Brain metastases occur in about 20-40% of patients with non-small-cell lung carcinoma (NSCLC), and are usually associated with a poor outcome. Whole brain radiotherapy (WBRT) is widely used but increasingly, more aggressive local treatments such as surgery or stereotactic radiosurgery (SRS) or stereotactic radiotherapy (SRT) are being employed. In our study we aimed to describe the various factors affecting outcomes in NSCLC patients receiving local therapy for brain metastases. Materials and Methods: The case records of 125 patients with NSCLC and brain metastases consecutively treated with radiotherapy at two tertiary centres from January 2006 to June 2012 were analysed for patient, tumour and treatment-related prognostic factors. Patients receiving SRS/SRT were treated using Cyberknife. Variables were examined in univariate and multivariate testing. Results: Overall median survival was 3.4 months (95%CI: 1.7-5.1). Median survival for patients with multiple metastases receiving WBRT was 1.5 months, 1-3 metastases receiving WBRT was 3.6 months and 1-3 metastases receiving surgery or SRS/SRT was 8.9 months. ECOG score (${\leq}2$ vs >2, p=0.001), presence of seizure (yes versus no, p=0.031), treatment modality according to number of brain metastases (1-3 metastases+surgery or $SRS/SRT{\pm}WBRT$ vs 1-3 metastases+WBRT only vs multiple metastases+WBRT only, p=0.007) and the use of post-therapy systemic treatment (yes versus no, p=0.001) emerged as significant on univariate analysis. All four factors remained statistically significant on multivariate analysis. Conclusions: ECOG ${\leq}2$, presence of seizures, oligometastatic disease treated with aggressive local therapy (surgery or SRS/SRT) and the use of post-therapy systemic treatment are favourable prognostic factors in NSCLC patients with brain metastases.

Keywords

Non-small cell lung carcinoma;brain metastases;stereotactic radiosurgery;Cyberknife

References

  1. Akhavan A, Binesh F, Heidari S (2014). Survival of brain metastatic patients in Yazd, Iran. Asian Pac J Cancer Prev, 15, 3571. https://doi.org/10.7314/APJCP.2014.15.8.3571
  2. Cai Y, Wang JY, Liu H (2013). Clinical observation of whole brain radiotherapy concomitant with targeted therapy for brain metastasis in non-small cell lung cancer patients with chemotherapy failure. Asian Pac J Cancer Prev, 14, 5699-703. https://doi.org/10.7314/APJCP.2013.14.10.5699
  3. Ceresoli GL, Reni M, Chiesa G, et al (2002). Brain metastases in locally advanced nonsmall cell lung carcinoma after multimodality treatment: risk factors analysis. Cancer, 95, 605-12. https://doi.org/10.1002/cncr.10687
  4. Chang EL, Wefel JS, Hess KR, et al (2009). Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol, 10, 1037-44. https://doi.org/10.1016/S1470-2045(09)70263-3
  5. Duan L, Zeng R, Yang KH, et al (2014). Whole brain radiotherapy combined with stereotactic radiotherapy versus stereotactic radiotherapy alone for brain metastases: a meta-analysis. Asian Pac J Cancer Prev, 15, 911-5. https://doi.org/10.7314/APJCP.2014.15.2.911
  6. Gaspar L, Scott C, Rotman M, et al (1997). Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys, 37, 745-51. https://doi.org/10.1016/S0360-3016(96)00619-0
  7. Gehan EA, Walker MD (1977). Prognostic factors for patients with brain tumors. Natl Cancer Inst Monograph, 46, 189-95.
  8. Hart MG, Grant R, Walker M, et al (2005). Surgical resection and whole brain radiation therapy versus whole brain radiation therapy alone for single brain metastases. Cochrane Database Syst Rev, 1.
  9. International Agency for Research on Cancer (2014). GLOBOCAN 2012: estimated cancer incidence, mortality and prevalence worldwide in 2012. World Health Organization. http://globocan.iarc.fr/Pages/fact_sheets_cancer.aspx. Accessed on 20 September 2014.
  10. Langley RE, Stephens RJ, Nankivell M, et al (2013). Interim data from the Medical Research Council QUARTZ trial: does whole brain radiotherapy affect the survival and quality of life of patients with brain metastases from non-small cell lung cancer? Clinical Oncol, 25, 23-30. https://doi.org/10.1016/j.clon.2012.11.002
  11. Law A, Karp DD, Dipetrillo T, Daly BT (2001). Emergence of increased cerebral metastasis after high-dose preoperative radiotherapy with chemotherapy in patients with locally advanced nonsmall cell lung carcinoma. Cancer, 92, 160-4. https://doi.org/10.1002/1097-0142(20010701)92:1<160::AID-CNCR1304>3.0.CO;2-X
  12. Liu WJ, Zeng XT, Qin HF, et al (2012). Whole brain radiotherapy plus chemotherapy in the treatment of brain metastases from lung cancer: a meta-analysis of 19 randomized controlled trails. Asian Pac J Cancer Prev, 13, 3253-8. https://doi.org/10.7314/APJCP.2012.13.7.3253
  13. Natukula K, Jamil K, Pingali UR, et al (2013). Survival analysis in advanced non small cell lung cancer treated with platinum based chemotherapy in combination with Paclitaxel, gemcitabine and Etoposide. Asian Pac J Cancer Prev, 14, 4661-6. https://doi.org/10.7314/APJCP.2013.14.8.4661
  14. Oken MM, Creech RH, Tormey DC, et al (1982). Toxicity and response criteria of the Eastern Cooperative Oncology Group. Am J Clinical Oncol, 5, 649-56. https://doi.org/10.1097/00000421-198212000-00014
  15. Patchell RA, Tibbs PA, Walsh JW, et al (1990). A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med, 322, 494-500. https://doi.org/10.1056/NEJM199002223220802
  16. Patil CG, Pricola K, Sarmiento JM, et al (2012). Whole brain radiation therapy (WBRT) alone versus WBRT and radiosurgery for the treatment of brain metastases. Cochrane Database Syst Rev, 9.
  17. Postmus PE, Smit EF (1999). Chemotherapy for brain metastases of lung cancer: a review. Ann Oncol, 10, 753-9. https://doi.org/10.1023/A:1008318515795
  18. Priestman TJ, Dunn J, Brada M, Rampling R, Baker PG (1996). Final results of the Royal College of Radiologists' trial comparing two different radiotherapy schedules in the treatment of cerebral metastases. Clin Oncol, 8, 308-15. https://doi.org/10.1016/S0936-6555(05)80717-4
  19. Sperduto PW, Berkey B, Gaspar LE, Mehta M, Curran W (2008). A new prognostic index and comparison to three other indices for patients with brain metastases: an analysis of 1,960 patients in the RTOG database. Int J Radiation Oncol Biol Phys, 70, 510-4. https://doi.org/10.1016/j.ijrobp.2007.06.074
  20. Sperduto PW, Chao ST, Sneed PK, et al (2010). Diagnosisspecific prognostic factors, indexes, and treatment outcomes for patients with newly diagnosed brain metastases: a multiinstitutional analysis of 4,259 patients. Int J Radiat Oncol Biol Phys, 77, 655-61. https://doi.org/10.1016/j.ijrobp.2009.08.025
  21. Van Vulpen M, Kal HB, Taphoorn MJ, El Sharouni SY (2002). Changes in blood-brain barrier permeability induced by radiotherapy: implications for timing of chemotherapy? Oncol Reports, 9, 683-8.
  22. Zeng YD, Zhang L, Liao H, et al (2012). Gefitinib alone or with concomitant whole brain radiotherapy for patients with brain metastasis from non-small-cell lung cancer: a retrospective study. Asian Pac J Cancer Prev, 13, 909-14. https://doi.org/10.7314/APJCP.2012.13.3.909

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