Kim Dae-Young, Lee Keun-Wook, Yun Tak, Kim Dong-Wan, Kim Tae-You, Heo Dae Seog, Bang Yung-Jue, Kim Noe Kyeong
Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, 28 Yongon-dong, Chongro-gu, Seoul 110-744, Korea.
Oncol Rep. 2005 Jul;14(1):207-11.
This study was conducted to assess the efficacy of systemic chemotherapy in patients with brain metastasis from non-small cell lung cancer. Sixty-three consecutive patients who were diagnosed as having non-small cell lung cancer (NSCLC) with synchronous brain metastasis (BM) and had not been previously treated were included in this study. After cranial radiation therapy (RT), all patients in 'the chemotherapy arm' (CTX) were treated with platinum-based combination chemotherapy, and best supportive care was selected for patients in 'the no-chemotherapy arm' (no-CTX). Thirty-one of the 63 patients received systemic chemotherapy. The median age of all patients was 55 years. The performance status of all patients was ECOG grade 1-2. Twenty-two patients had a solitary brain metastasis, 37 patients had more than two masses, and 38 patients had extracranial metastatic lesions. In the CTX arm, a paclitaxel-based combination chemotherapy was administered in 38.7%, gemcitabine-based in 25.8%, and vinorelbine-based in 25.8% as the first-line chemotherapy. Seventeen patients were treated with a second-line chemotherapy, and paclitaxel plus gemcitabine was used in 8 patients. For the first-line and second-line chemotherapies, extracranial overall responses were 36 and 35%, the median response durations were 29.1 weeks (range: 9.1-58.1 weeks) and 30.4 weeks (range: 19.4-44.0 weeks), respectively. 'Progression of the extracranial lesion' (58.1%) was more frequent than an 'aggravation of neurologic status' (19.4%) for the pattern of treatment failure in the first-line chemotherapy. The causes of failure were identical in the second-line chemotherapy. The median survival of the CTX arm was longer than that of the no-CTX arm (58.1 vs. 19.0 weeks, p<0.001). Toxicity in the CTX arm was tolerable. The systemic chemotherapy showed an effectiveness to increase the survival of patients with BM from NSCLC, and extracranial progression was the main cause of chemotherapeutic failure, although consideration for non-randomized methods should be made in this study.
本研究旨在评估全身化疗对非小细胞肺癌脑转移患者的疗效。本研究纳入了63例连续诊断为非小细胞肺癌（NSCLC）并伴有同步脑转移（BM）且此前未接受过治疗的患者。在进行颅脑放射治疗（RT）后，“化疗组”（CTX）的所有患者均接受铂类联合化疗，而“非化疗组”（no-CTX）的患者则选择最佳支持治疗。63例患者中有31例接受了全身化疗。所有患者的中位年龄为55岁。所有患者的体能状态为ECOG 1-2级。22例患者有孤立性脑转移，37例患者有两个以上肿块，38例患者有颅外转移病灶。在CTX组中，38.7%的患者接受了以紫杉醇为基础的联合化疗，25.8%的患者接受了以吉西他滨为基础的化疗，25.8%的患者接受了以长春瑞滨为基础的化疗作为一线化疗。17例患者接受了二线化疗，其中8例患者使用了紫杉醇加吉西他滨。对于一线和二线化疗，颅外总体缓解率分别为36%和35%，中位缓解持续时间分别为29.1周（范围：9.1-58.1周）和30.4周（范围：19.4-44.0周）。在一线化疗的治疗失败模式中，“颅外病变进展”（58.1%）比“神经功能状态恶化”（19.4%）更常见。二线化疗的失败原因相同。CTX组的中位生存期长于no-CTX组（58.1对19.0周，p<0.001）。CTX组的毒性是可耐受的。全身化疗显示出可提高NSCLC脑转移患者的生存率，尽管本研究应考虑非随机方法，但颅外进展是化疗失败的主要原因。
