Development of symptomatic brain metastases after chemoradiotherapy for stage III non-small cell lung cancer: Does the type of chemotherapy regimen matter?

作者：Hendriks Lizza E L^*; Brouns Anita J W M; Amini Mohammad; Uyterlinde Wilma; Wijsman Robin; Bussink Jan; Biesma Bonne; Oei S Bing; Stigt Jos A; Bootsma Gerben P; Belderbos Jose S A; De Ruysscher Dirk K M; Van den Heuvel Michel M; Dingemans Anne Marie C

来源：Lung Cancer, 2016, 101: 68-75.

DOI：10.1016/j.lungcan.2016.09.008

• NSCLC
• Stage III
• Chemoradiation
• Chemotherapy
• Symptomatic brain metastases

Objectives: Symptomatic brain metastases (BM) occur frequently after chemoradiotherapy (CRT) for stage III NSCLC. Aim of the current study was to determine whether the specific chemotherapy used in a CRT regimen influences BM development.
Materials and methods: Retrospective multicenter study including all consecutive stage III NSCLC who completed CRT. Primary endpoints: symptomatic BM development, whether this was the only site of first relapse. Differences between regimens were assessed with a logistic regression model including known BM risk factors and the specific chemotherapy: concurrent versus sequential (cCRT/sCRT), within cCRT: daily low dose cisplatin (LDC)-cyclic dose polychemotherapy; LDC-(non-)taxane cyclic dose; LDC-polychemotherapy subgroups of >= 50 patients.
Results: Between January 2006 and June 2014, 838 patients were eligible (737 cCRT, 101 5CRT). 18.2% developed symptomatic BM, 8.0% had BM as only site of first relapse. BM patients were significantly younger, female, had more advanced N-stage and had adenocarcinoma histology. In both cCRT and sCRT BM were found in 18% (p=0.904). In cyclic dose cCRT (N=346) and LDC (N=391) BM were found in 18.8% and 17.9%, respectively (p=0.757). In 7.2% and 8.7%, respectively, BM were the only site of first relapse (p = 0.463). The chemotherapy used (cCRT versus SCRT) had no influence on BM development, not for all brain relapses nor as only site of first relapse (OR 0.88 (p= 0.669), OR 0.93 (p = 0.855), respectively). LDC versus cyclic dose cCRT was not significantly different: neither for all brain relapses nor as only site of first relapse (OR 0.96 (p = 0.819), OR 1.21 (p= 0.498), respectively).Comparable results were found for LDC versus cyclic dose non-taxane (N = 277) and cyclic dose taxane regimens (N = 69) and for cCRT regimens with >= 50 patients (LDC versus cisplatin/etoposide (N=188), cisplatin/vinorelbin (N= 65), weekly cisplatin/docetaxel (N= 60)).
Conclusion: approximately 18% developed symptomatic BM after stage III diagnosis, not dependent on type of chemotherapy regimen used within a CRT treatment.

• 出版日期2016-11