Moscetti Luca, Nelli Fabrizio, Felici Alessandra, Rinaldi Massimo, De Santis Stefano, D'Auria Giuliana, Mansueto Giovanni, Tonini Giuseppe, Sperduti Isabella, Pollera Francesco C
Department of Medical Oncology, Central Hospital of Belcolle, Viterbo, Italy.
Cancer. 2007 Jan 15;109(2):274-81. doi: 10.1002/cncr.22399.
For patients with stage IV nonsmall cell lung cancer (NSCLC) who present with brain metastasis (BMs), standard platinum-based chemotherapy regimens have challenged the role of up-front whole-brain radiotherapy (WBRT).
In this survey, the authors analyzed the decision tree by which 6 oncologic centers guided the pattern of care in an unselected population of patients with NSCLC who presented with BMs at first diagnosis. The impact of front-line, platinum-based chemotherapy also was evaluated. Individual data were reviewed from 156 eligible patients who were referred to participating centers.
Up-front treatment included chemotherapy in 110 patients and WBRT followed by chemotherapy in 46 patients. The selection of first treatment was guided based mainly on the presence of by BM symptoms, with chemotherapy selected for 24% of patients in the chemotherapy cohort and for 76% of patients in the chemotherapy and WBRT cohort. Regardless of treatment, the brain response was 29% (27% and 35% for the chemotherapy and WBRT cohorts, respectively; P value not significant). For the entire population, the overall response rate was 37%, progression-free survival was 6 months, and the median survival was 11 months. At multivariate analysis, significant predictors for survival were: brain response (hazard ratio [HR], 2.59; P = .0001), modified Radiation Therapy Oncology Group class (HR, 0.87; P = .003), and Eastern Cooperative Oncology Group performance status (HR, 1.49; P = .04).
For patients with NSCLC who present with BMs at first diagnosis, the results of the current survey confirmed that the expected benefit of platinum-based chemotherapy may be translated into clinical practice and that selected subsets of patients who receive frontline chemotherapy (ie, patients in whom BM symptoms are absent or are controlled by supportive therapy) may be spared from WBRT. Further prospective studies evaluating different approaches and interventions are warranted.
对于出现脑转移（BMs）的IV期非小细胞肺癌（NSCLC）患者，标准的铂类化疗方案对 upfront 全脑放疗（WBRT）的作用提出了挑战。
在本次调查中，作者分析了6个肿瘤中心在未选择的初诊时伴有BMs的NSCLC患者群体中指导治疗模式的决策树。还评估了一线铂类化疗的影响。回顾了转至参与中心的156例符合条件患者的个体数据。
upfront治疗包括110例患者接受化疗，46例患者接受WBRT后化疗。首次治疗的选择主要基于BM症状的存在，化疗队列中24%的患者选择化疗，化疗和WBRT队列中76%的患者选择化疗。无论治疗如何，脑部缓解率为29%（化疗队列和WBRT队列分别为27%和35%；P值无统计学意义）。对于整个人群，总缓解率为37%，无进展生存期为6个月，中位生存期为11个月。多因素分析显示，生存的显著预测因素为：脑部缓解（风险比[HR]，2.59；P = .0001）、改良的放射治疗肿瘤学组分级（HR，0.87；P = .003）和东部肿瘤协作组体能状态（HR，1.49；P = .04）。
对于初诊时伴有BMs的NSCLC患者，本次调查结果证实基于铂类化疗的预期益处可转化为临床实践，并且接受一线化疗的特定患者亚组（即无BM症状或症状由支持治疗控制的患者）可能无需接受WBRT。有必要进一步开展评估不同方法和干预措施的前瞻性研究。
