title: Radiation-Refractory Brain Metastases in Patients with Non-Small Cell Lung Cancer.
abstract: BACKGROUND
  Numerous studies have focused on the treatment of non-small cell lung cancer patients with brain metastases. However, to our knowledge, few have sought to examine outcomes in patients who required whole brain radiation and developed radiation-refractory disease.
  
  
  METHODS
  This study examined the medical records of all non-small cell lung cancer patients who developed brain metastases between 2004 and 2013, required whole brain radiation, and received their cancer treatment at the Mayo Clinic in Rochester, Minnesota.
  
  
  RESULTS
  A total of 141 patients, most of whom were symptomatic, met the above criteria. Of these, 33 (23%) did not tolerate a corticosteroid taper and were therefore deemed to have radiation-refractory disease. The median survival of patients with and without radiation-refractory disease was 3.12 and 4.27 months, respectively, (hazard ratio [HR]: 0.65 [95% confidence interval (CI): 0.44-0.99]; p=0.04 by log rank test). In a subgroup analysis of patients with radiation-refractory disease (n=33) and radio-responsive disease (n=43), median survival was 3.12 and 5.94 months, respectively (HR: 0.43 [95% CI: 0.26-0.70]). Among patients with radiation-refractory disease, 12 received chemotherapy after radiation, and two received erlotinib. Systemic therapy was associated with improved symptoms in two patients but did not appear to improve survival.
  
  
  CONCLUSIONS
  Non-small cell lung cancer patients with radiation-refractory brain metastases represent a small subgroup who have a short survival and who appear to derive minimal benefit from systemic cancer therapy.
authors.affiliation: 1 Department of Medicine, Mayo Clinic , Rochester, Minnesota.
authors.forename: Clayton M
authors.initials: CM
authors.lastname: Spiceland
authors.affiliation: 2 Department of Radiation Oncology, Mayo Clinic , Rochester, Minnesota.
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Olivier
authors.affiliation: 3 Department of Oncology, Mayo Clinic , Rochester, Minnesota.
authors.forename: Aminah
authors.initials: A
authors.lastname: Jatoi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000188:drug therapy / Q000532:radiotherapy* / Q000556:secondary*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000532:radiotherapy* / Q000556:secondary*; D000069347:Erlotinib Hydrochloride / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D015996:Survival Rate; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D000069347:Erlotinib Hydrochloride