Whole brain radiation therapy followed by intensity-modulated boosting treatment combined with concomitant temozolomide for brain metastases from non-small-cell lung cancer

Brain metastases (BMs) represent an important cause of morbidity in patients with non-small-cell lung cancer (NSCLC) and are associated with a mean survival of < 1 year. Thus, new regimens improving the outcome of these patients are urgently needed. We have evaluated the response to treatment, overall survival, disease progression, and adverse effects of a concomitant treatment with whole brain radiation therapy (WBRT) followed by intensity-modulated boosting RT (IMBRT) and temozolomide (TMZ) in patients with BMs from NSCLC. A total of 32 patients with no more than four BMs were enrolled in this retrospective study. Patients received 30 Gy of WBRT in 15 fractions and followed by 20 Gy of IMBRT in 10 fractions with concomitant TMZ of 75 mg/m(2)/day orally during RT and continued TMZ therapy (150-200 mg/m(2)/day for 5 days every 28 days for an additional 2-6 cycles after RT). Three patients had a complete response, 9 patients had a partial response, while 15 patients had stable disease; therefore, the objective responses achieved 37.5 %. Median overall survival was 8.0 months and median time to progression was 5.5 months. Common treatment-related adverse effects (Grade a parts per thousand currency sign2) included nausea, vomiting, and asthenia. Grade 3 or worse hematologic toxicities were rare. No patient presented with gross neurocognitive dysfunction. WBRT followed by IMBRT combined with concomitant TMZ is well tolerated, yielding an encouraging objective response rate; however, overall survival improves slightly comparing with RTOG 9508 randomized trial.