[Sequential treatment of VmP regimen and whole brain radiotherapy for small cell lung cancer patients with brain metastases].
OBJECTIVE
Median survival time (MST) of small cell lung cancer (SCLC) patients with brain metastases was short when patients were palliatively treated with either chemotherapy or whole brain radiotherapy (WBRT). This study was designed to compare therapeutic effects,toxicities,and survival time of 2 different sequential treatments of VmP regimen and WBRT for SCLC patients with brain metastases.


METHODS
According to bed availability, 38 naive SCLC patients with brain metastases were nonrandomized into group A and group B. There was no significant difference of characteristics between 2 groups (Chi-s Fisher's exact test, P >0.05). Patients in group A (VmP-WBRT) received 2 cycles of VmP regimen (teniposide, 60 mg/m(2),d(1-5), cisplatin, 25 mg/m(2), d(1-3), repeated every 4 weeks),and then WBRT (3 Gy x 10,within 2 weeks); patients in group B (WBRT-VmP) received the same WBRT in advance,and then 2 cycles of VmP regimen. Patients with single brain lesion received an extra 3 Gy x 5 radiotherapy on the limited field of brain lesion within 1 week after WBRT. All patients received 2-4 cycles of chemotherapy after sequential treatments.


RESULTS
Both sequential treatments relieved neurological symptoms of more than 80% of patients. Response rates of brain,lung,and total lesions of group A and B had no significant differences (68.2% vs. 75.0%, P=0.647; 77.3% vs. 75%, P=0.871; 63.6% vs. 56.3%, P=0.646,respectively). Time to progression (TTP) of group A was 6.0 (95% CI 4.4-7.6) months,of group B was 5.0 (95% CI 3.6-6.4) months (P=0.383). MST of group A was 12.0 (95% CI 7.9-16.1) months,of group B was 9.0 (95% CI 5.6-12.4) months (P=0.049). One-year survival rate of group A was 31.8%,of group B was 18.8% (P=0.281),and 2-year survival rates were 13.6%, and 6.3% (P=0.844). Myelosuppression was the main concentration-dependent toxicity. Incidence of vomit at stage III in group B was higher than that in group A (P=0.01). All treatment toxicities were tolerable and manageable.


CONCLUSIONS
Both sequential treatments can be safely performed for SCLC patients with brain metastases, may relieve neurological symptoms, and well control both primary and metastatic lesions. VmP-WBRT sequential treatment may prolong survival time of SCLC patients for 3 months.
Yue
Xiang
X
Department of Medical Oncology, Nanjing Drum Tower Hospital, Medical College, Nanjing University, Nanjing, Jiangsu 210008, P.R. China. yx550405@sina.com.cn
Zang
Qin-Chuan
QC
D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D018288:Carcinoma, Small Cell / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D002945:Cisplatin / Q000008:administration & dosage; D003131:Combined Modality Therapy; D016371:Cranial Irradiation / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007970:Leukopenia / Q000209:etiology; D008175:Lung Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015996:Survival Rate; D013713:Teniposide / Q000008:administration & dosage
D013713:Teniposide; D002945:Cisplatin