Factors affecting the risk of brain metastases after definitive chemoradiation for locally advanced non-small-cell lung carcinoma

被引:136
作者
Robnett, TJ
Machtay, M
Stevenson, JP
Algazy, KM
Hahn, SM
机构
[1] Hosp Univ Penn, Dept Radiat Oncol, Philadelphia, PA 19104 USA
[2] Hosp Univ Penn, Div Med Oncol, Dept Med, Philadelphia, PA 19104 USA
关键词
D O I
10.1200/JCO.2001.19.5.1344
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: As therapy for locally advanced nonsmall-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. Methods: 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 herd 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. Results: 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 5-year BM rate of 42% (P < .01 v all others). Examining treatment-related parameters, crude and 2-year actuarial risk of BMI were 27% and 39%, respectively, in patients receiving chemotherapy before radiotherapy and 15% and 20%, respectively, when radiotherapy wets not delayed (P < .05). On multivariate analysis, timing of chemotherapy (P < .01) and stage IIIA versus IIIB (P < .01) remained significant. Conclusion: patients with later stage, nonsquamous NSCLC, particularly those receiving induction chemotherapy, have sufficiently common BM rates to justify future trials including prophylactic cranial irradiation. J Clin Oncol 19:1344-1349. (C) 2001 by American Society of Clinical Oncology.
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页码:1344 / 1349
页数:6
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