Phase II study of temozolomide and concomitant whole-brain radiotherapy in patients with brain metastases from solid tumors.
BACKGROUND
The aim of this study was to evaluate the effectiveness and possible toxicity of the combination of temozolomide (TMZ) with whole-brain irradiation (WBI) in the treatment of brain metastases from solid tumors.


METHODS
33 patients with brain metastases were included in the study and treated with TMZ 60 mg/m2/day (days 1-16) concomitantly with WBI (36 Gy/12 fractions given in 16 days). One month after the end of radiotherapy, 6 cycles of TMZ were administered as adjuvant treatment (200 mg/m2/day for 5 consecutive days every 28 days).


RESULTS
Responses were assessed using computed tomography at the end of the 3rd and 6th cycle of chemotherapy. The objective response rate was 54.5% and 57.6% after the 3rd and the 6th cycle, respectively. The median overall survival was 12 months. In patients with metastases from lung cancer the objective response rate was 11/14 (78.6%) after both the 3rd and the 6th cycle of treatment. The most common side effects were anemia (24.2%), thrombocytopenia (18.2%), as well as nausea and vomiting (18.2%). The high incidence of hepatotoxicity (45.5%) might be related to concomitantly administered antiepileptic drugs and not to TMZ.


CONCLUSIONS
WBI combined with TMZ as concomitant and adjuvant treatment is effective in treating brain metastases, with acceptable mild side effects.
Kouvaris
John R
JR
Department of Radiation Oncology, University of Athens, Greece. johnkouv@aretaieio.uoa.gr
Miliadou
Anthi
A
Kouloulias
Vassilis E
VE
Kolokouris
Dimitrios
D
Balafouta
Myrsini J
MJ
Papacharalampous
Xenofon N
XN
Vlahos
Lambros J
LJ
D000368:Aged; D000369:Aged, 80 and over; D018906:Antineoplastic Agents, Alkylating / Q000009:adverse effects / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary; D018288:Carcinoma, Small Cell / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary; D017024:Chemotherapy, Adjuvant; D017322:Clinical Trials, Phase II as Topic; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D003606:Dacarbazine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D008297:Male; D008545:Melanoma / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000556:secondary; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D009382:Neoplasms, Unknown Primary / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D010166:Palliative Care; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy; D012107:Research Design; D000077204:Temozolomide; D016896:Treatment Outcome
D018906:Antineoplastic Agents, Alkylating; D003606:Dacarbazine; D000077204:Temozolomide