Petrović Marina, Ilić Nevenka, Loncarević Olivera, Cekerevać Ivan, Lazić Zorica, Novković Ljiljana, Cupurdija Vojislav, Kostić Gordana
University of Kragujevac, Faculty of Medicine, Kragujevac, Serbia.
Vojnosanit Pregl. 2011 Aug;68(8):643-9. doi: 10.2298/vsp1108643p.
INTRODUCTION/AIM: Lung cancer is a leading cause of mortality among patients with carcinomas. The aim of this study was to point out risk factors for brain metastases (BM) appearance in patients with IIIA (N2) stage of nonsmall cell lung cancer (NSCLC) treated with three-modal therapy.
We analyzed data obtained from 107 patients with IIIA (N2) stage of NSCLC treated surgically with neoadjuvant therapy. The frequency of brain metastases was examined regarding age, sex, histological type and the size of tumor, nodal status, the sequence of radiotherapy and chemotherapy application and the type of chemotherapy.
Two and 3-year incidence rates of BM were 35% and 46%, respectively. Forty-six percent of the patients recurred in the brain as their first failure in the period of three years. Histologically, the patients with nonsquamous cell lung carcinoma had significantly higher frequency of metastases in the brain compared with the group of squamous cell lung carcinoma (46%:30%; p = 0.021). Examining treatment-related parameters, treatment with taxane-platinum containing regimens was associated with a lower risk of brain metastases, than platinum-etoposide chemotherapy regimens (31%:52%; p = 0.011). Preoperative radiotherapy, with or without postoperative treatment, showed lower rate of metastases in the brain compared with postoperative radiotherapy treatment only (33%:48%; p = 0.035).
Brain metastases are often site of recurrence in patients with NSCLC (IIIA-N2). Autonomous risk factors for brain metastases in this group of patients are non-squamous NSCLC, N1-N2 nodal status, postoperative radiotherapy without preoperative radiotherapy.
引言/目的：肺癌是癌症患者死亡的主要原因。本研究的目的是指出接受三联疗法治疗的非小细胞肺癌（NSCLC）IIIA（N2）期患者发生脑转移（BM）的危险因素。
我们分析了107例接受新辅助治疗后手术的NSCLC IIIA（N2）期患者的数据。就年龄、性别、组织学类型、肿瘤大小、淋巴结状态、放疗和化疗应用顺序以及化疗类型检查脑转移的发生率。
BM的2年和3年发生率分别为35%和46%。46%的患者在三年内首次复发部位为脑。组织学上，非鳞状细胞肺癌患者脑转移发生率显著高于鳞状细胞肺癌组（46%:30%；p = 0.021）。检查与治疗相关的参数，含紫杉烷-铂方案的治疗与脑转移风险较低相关，低于铂-依托泊苷化疗方案（31%:52%；p = 0.011）。术前放疗，无论有无术后治疗，与仅术后放疗相比，脑转移率较低（33%:48%；p = 0.035）。
脑转移是NSCLC（IIIA-N2）患者常见的复发部位。该组患者脑转移的独立危险因素是非鳞状NSCLC、N1-N2淋巴结状态、无术前放疗的术后放疗。
