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Treatment options for brain metastases in patients with non-small-cell lung cancer

Current Oncology Reports volume 5, pages 342–346 (2003)Cite this article

Abstract

Brain metastases are a common complication for patients with non-small-cell lung cancer and a significant cause of morbidity and mortality. In the past, treatment of brain metastases and lung cancer focused on symptom palliation with whole-brain radiotherapy (WBRT) and steroids because of the grim outlook for patients. However, recent advances in technology and surgical techniques have created more options for the management of brain metastases, which include surgery, irradiation, stereotactic radiosurgery, and chemotherapy. These aggressive approaches have resulted in an improvement of neurologic outcomes and survival rates of patients with non-small-cell lung cancer. Central nervous system (CNS) metastases can be divided into three groups: solitary CNS metastases with controlled or controllable primary disease, oligometastatic disease (fewer than 3 metastases), and multiple metastases. For patients with solitary CNS metastases, long-term survival is possible. A radical treatment approach involving surgical resection or radiosurgery, followed by WBRT, is recommended. For patients with oligometastatic disease, surgical resection or radiosurgery is considered in selected cases and WBRT is indicated. For patients with multiple metastases, WBRT is recommended. For patients with oligometastatic disease and those with multiple metastases, recent evidence indicates that systemically effective chemotherapy may produce responses and can be instituted safely before radiotherapy. The treatment timing of chemotherapy and radiotherapy should be individualized.

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References and Recommended Reading

  1. Zimm S, Wampler GL, Stablein D, et al.: Intra-cerebral metastases in solid tumor patients: natural history and results of treatment. Cancer 1981, 15:384–395.

    Article  Google Scholar 

  2. Kelly K, Bunn PA Jr: Is it time to reevaluate our approach to the treatment of brain metastases in patients with non-small cell lung cancer? Lung Cancer 1998, 2:85–91. Clear and concise review of the data regarding the benefits of treatment in varying subsets of patients with CNS metastases.

    Article  Google Scholar 

  3. Law A, Karp DD, Dipetrillo T, Daly BT: Emergence of increased cerebral metastasis after high-dose preoperative radiotherapy with chemotherapy in patients with locally advanced nonsmall cell carcinoma. Cancer 2001, 92:160–164.

    PubMed  Article  CAS  Google Scholar 

  4. Komaki R, Scott CB, Sauce WT, et al.: Induction cisplatin/vinblastine and irradiation vs irradiation in un-resectable squamous cell lung cancer failure patterns by cell type in RTOG 88-08/ECOG 4588. Int J Radiat Oncol Biol Phys 1997, 39:537–544.

    PubMed  Article  CAS  Google Scholar 

  5. Rusch VW, Giroux DJ, Kraut MJ, et al.: Induction chemoradiation and surgical resection for non-small cell lung carcinomas of the superior sulcus: initial results of Southwest Oncology Group Trial 9416 (Intergroup Trial 0160). J Thorac Cardiovasc Surg 2001, 121:472–473.

    PubMed  Article  CAS  Google Scholar 

  6. Borgelt B, Gelber R, Kramer S, et al.: The palliation of brain metastasis: final results of two studies by Radiation Therapy Oncology Group. Int J Radiat Oncol Biol Phys 1980, 6:1–9.

    PubMed  CAS  Google Scholar 

  7. Posner JB: Management of central nervous system metastases. Semin Oncol 1977, 4:81–91.

    PubMed  CAS  Google Scholar 

  8. Leksell L: A stereotactic apparatus for intra-cerebral surgery. Acta Chir Scand 1949, 99:231.

    Google Scholar 

  9. Sneed PK, Lamborn KR, Torstner JM, et al.: Radio-surgery for brain metastases: is whole brain radiotherapy necessary? Int J Radiat Oncol Biol Phys 1999, 3:549–558.

    Article  Google Scholar 

  10. Flickinger JC, Kondziolka D, Lunsford LD, et al.: A multi-institutional experience with stereotactic radiosurgery for solitary brain metastasis. Int J Radiat Oncol Biol Phys 1994, 28:797–802. A large multi-institutional study on the effectiveness of SRS for patients with solitary brain metastasis.

    PubMed  CAS  Google Scholar 

  11. Li B, Yu J, Suntharlingam M, et al.: Comparison of three treatment options for single brain metastasis from lung cancer. Int J Cancer Radiat Oncol Invest 2000, 90:37–45.

    CAS  Google Scholar 

  12. Patchell RA, Tibbs PA, Walsh JW, et al.: A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 1990, 322:494–500. ssic study indicating the benefit of aggressive treatment of patients with CNS metastases. This paper provides important prospective data regarding which patient subsets benefit from surgical resection

    PubMed  CAS  Article  Google Scholar 

  13. Patchell RA, Tibbs PA, Regine WF, et al.: Postoperative radiotherapy in the treatment of single metastases to the brain: a randomized trial. JAMA 1998, 280:1485–1489. low-up trial to Patchell et al. [12] indicating the benefit of WBRT after resection.

    PubMed  Article  CAS  Google Scholar 

  14. Torre M, Quaini E, Chisea G, et al.: Synchronous brain metastasis from lung cancer: result of treatment in combined resection. J Thorac Cardiovasc Surg 1988, 95:994–997.

    PubMed  CAS  Google Scholar 

  15. Chidel M, Suh J, Greskovich J, et al.: Treatment outcome for patients with primary non-small-cell lung cancer and synchronous brain metastasis. Radiat Oncol Invest 1999, 7:313–319.

    Article  CAS  Google Scholar 

  16. Edelman MJ, Khanwani SL: Advanced non-small cell lung cancer. Curr Treat Options in Oncol 2001, 2:51–62.

    CAS  Google Scholar 

  17. Robinet G, Thomas P, Breton JL, et al.: Results of a phase III study of early versus delayed whole brain radiotherapy with concurrent cisplatin and vinorelbine combination in inoperable brain metastasis of non-small cell lung cancer: Groupe Francais de Pneumo-Cancerologie (GFPC) Protocol 95-1. Ann Oncol 2001, 12:59–67. s paper demonstrates clearly that systemic chemotherapy is active in the CNS and that delay of radiotherapy does not compromise patient outcome

    PubMed  Article  CAS  Google Scholar 

  18. Cotto C, Berille J, Souquet PJ, et al.: A phase II trial of fotemustine and cisplatin in central nervous system metastases from non-small cell lung cancer. Eur J Cancer 1996, 32:69–71.

    Article  Google Scholar 

  19. Minotti V, Cino L, Meacci ML, et al.: Chemotherapy with cisplatin and etoposide for cerebral metastases in non-small cell lung cancer. Lung Cancer 1998, 20:93–98.

    PubMed  Article  CAS  Google Scholar 

  20. Lee JS, Pisters KM, Komaki R, et al.: Paclitaxel and carboplatin chemotherapy as a primary treatment of brain metastases in patients with non-small cell lung cancer [abstract]. Proc ASCO 2000, 19:501a.

    Google Scholar 

  21. Abrey LE, Olson JD, Boutros DY, et al.: A phase II study of temozolomide for recurrent brain metastases [abstract]. Proc ASCO 2000, 19:166a.

    Google Scholar 

  22. Abrey L, Christodoulou C: Temozolomide for treating brain metastases. Semin Oncol 2001, 28(Suppl_13):34–42.

    PubMed  Article  CAS  Google Scholar 

  23. PatchellTurrisi AT: Brain irradiation and systemic chemotherapy for small-cell lung cancer: dangerous liaisons? J Clin Oncol 1990, 8:196–199. torial summarizing the literature and potential risks of concurrent chemotherapy and radiotherapy in the treatment of patients with CNS metastases. Although the paper is focused on small-cell lung cancer, the discussion is applicable to NSCLC

    Google Scholar 

  24. Cohen N, Strauss G, Lew R, et al.: Should prophylactic anticonvulsants be administered to patients with newly diagnosed cerebral metastases? A retrospective analysis. J Clin Oncol 1988, 6:1621–1624. An important paper indicating that anticonvulsants do not need to be administered routinely to every patient with newly diagnosed CNS metastases

    PubMed  CAS  Google Scholar 

  25. Burt M, Wronski M, Arbit E, Galicich JH: Resection of brain metastases from non-small-cell lung carcinoma. J Thorac Cardiovasc Surg 1992, 103:399–411.

    PubMed  CAS  Google Scholar 

  26. PatchellWeisman DE: Glucocorticoid treatment for brain metastases and epidural spinal cord compression: a review. J Clin Oncol 1988, 6:534–551. Execellent review of the mechanism and results of steroid therapy for CNS metastases.

    Google Scholar 

  27. Glantz MJ, Cole BF, Forsyth PA, et al.: Anticonvulsant prophylaxis in patients with brain tumors: a systematic review of evidence. Neurology 2000, 54:1886–1893.

    PubMed  CAS  Google Scholar 

  28. Werk EE, Choi Y, Sholiton Z, et al.: Interference in the effect of dexamethasone by diphenylhydantoin. N Engl J Med 1969, 281:32–34.

    PubMed  Article  Google Scholar 

  29. Lawson LA, Blouin RA, Smith RB, et al.: Phenytoin-dexamethasone interaction: a previously unreported observation. Surg Neurol 1981, 16:23.

    PubMed  Article  CAS  Google Scholar 

  30. Shiau CY, Sneed PK, Shu HKG, et al.: Radiosurgery for brain metastases: relationship of dose and pattern of enhancement to local control. Int J Radiat Oncol Biol Phys 1997, 37:375–383.

    PubMed  Article  CAS  Google Scholar 

  31. Kihlstrom L, Karlsson B, Lindquist C: Gamma-knife surgery for cerebral metastases: implications for survival based on 16 years experience. Stereotact Funct Neurosurg 1993, 1:45–50.

    Article  Google Scholar 

  32. Hoffman R, Sneed PK, McDermott MW, et al.: Radiosurgery for brain metastases from primary lung carcinoma. Cancer J 2001, 7:121–131.

    PubMed  CAS  Google Scholar 

  33. Shu HKG, Sneed PK, Shiau CY, et al.: Factors influencing survival after gamma knife radiosurgery for patients with single and multiple brain metastases. Cancer J Sci Am 1996, 2:335.

    PubMed  CAS  Google Scholar 

  34. Mehta M, Shapiro WR, Glantz MJ, et al.: Lead-in phase to randomized trial of motexafin gadolinium and whole brain radiation for patients with brain metastases: centralized assessment of magnetic resonance imaging, neurocognitive and neurologic endpoints. J Clin Oncol 2002, 20:3445–3453.

    PubMed  Article  CAS  Google Scholar 

  35. Moriarty TM, Loeffler JS, Black PM, et al.: Long-term follow-up of patients treated with stereotactic radiosurgery for single or multiple brain metastases. In Radiosurgery. Edited by Kondziolka D. Basel: Karger; 1995:83–91.

    Google Scholar 

  36. Adler JR, Cox RS, Kaplan I, Martin DP: Stereotactic radiosurgical treatment of brain metastases. J Neurosurg 1992, 76:444–449.

    PubMed  CAS  Article  Google Scholar 

  37. Mehta MP, Rozentall JM, Levin AB, et al.: Defining the role of radiosurgery in the management of brain metastases. Int J Radiat Oncol Biol Phys 1992, 24:619–625.

    PubMed  CAS  Google Scholar 

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Affiliations

  1. Division of Hematology/Oncology, University of Maryland Greenebaum Cancer Center, 22 South Greene Street, 21201, Baltimore, MD, USA

    Martin J. Edelman MD

Authors
  1. Sadaf Taimur MD
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  2. Martin J. Edelman MD
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Taimur, S., Edelman, M.J. Treatment options for brain metastases in patients with non-small-cell lung cancer. Curr Oncol Rep 5, 342–346 (2003). https://doi.org/10.1007/s11912-003-0077-8

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  • DOI: https://doi.org/10.1007/s11912-003-0077-8

Keywords

  • Brain Metastasis
  • Radiat Oncol Biol Phys
  • Stereotactic Radiosurgery Stereotactic
  • Central Nervous System Metastasis
  • Prophylactic Cranial Irradiation