Emergence of increased cerebral metastasis after high-dose preoperative radiotherapy with chemotherapy in patients with locally advanced nonsmall cell lung carcinoma

BACKGROUND. In recent years, combined modality induction therapy has defined a new standard of care in the treatment of patients with American Joint Committee on Cancer (ATCC) Stage III nonsmall cell lung carcinoma, providing improved local control and improved disease-free survival. However, the majority of Stage III patients still die of recurrent disease. METHODS. Forty-two consecutive patients with AJCC Stage IIIA/IIIB nonsmall cell lung carcinoma (NSCLC) who were undergoing induction chemoradiotherapy followed by surgical resection of the primary NSCLC tumor between December 1, 1987 and September 1, 1999 were analyzed for resectability, survival, and patterns of disease failure. These patients received cisplatin (60 mg/m(2)) on Days 1 and 22 and etoposide (100 mg/m(2)) on Days 1, 2, and 3, and Days 22, 23, and 24 together with 5940 centigrays (cGy) of radiation in 180-cGy fractions delivered over 6 weeks. RESULTS. Thirty-one of the 42 patients (74%) underwent surgical resection of the primary lung tumor and mediastinal lymph nodes after chemoradiotherapy. No surgical deaths were reported. The median survival of these 31 patients was 52 months. The 5-year survival estimate using the Kaplan-Meier method was 49.9%. The local control rate was 80%. The incidence of distant metastases other than in the brain was reduced. The most frequently involved site of isolated first recurrence was the brain. The median time to brain recurrence was 7.5 months from the time of surgical resection. All brain metastases were detected within 2 years. CONCLUSIONS. The high incidence of isolated brain metastasis after induction chemoradiotherapy and curative resection and their response to treatment suggest that routine scans of the brain may be indicated in the follow-up of patients with locally advanced NSCLC. Cancer 2001;92:160-4. (C) 2001 American Cancer Society.