Long-term survival following concurrent chemoradiotherapy in patients with non-small-cell lung cancer with concomitant brain metastases only

Abstract

We report two patients with non-small-cell lung cancer (NSCLC) with concomitant metastases to the brain only who received chemotherapy with concurrent radiotherapy for the thoracic disease and brain disease, resulting in long-term survival. One patient was a 56-year-old woman who was diagnosed as having adenocarcinoma and showed T2N1 thoracic disease; the other patient was a 57-year-old man diagnosed with squamous cell carcinoma who had T1N3 thoracic disease. Both patients demonstrated multiple metastases to the brain only. Chemotherapy, consisting of cisplatin (40 mg/m2) and docetaxel (40 mg/m2), was administered on days 1 and 8, with the drugs being given separately, and the chemotherapy was repeated every 4 weeks for up to three cycles. Whole-brain irradiation (2 Gy/day; total, 36 Gy) and thoracic irradiation (2 Gy/day; total, 60 Gy) were started on days 1 and 29, respectively. Toxicities encountered were manageable by conventional therapy. The concurrent chemoradiation therapy resulted in complete regression of the brain disease in both patients. Brain disease relapsed in the female patient, but it is being controlled by the administration of gefitinib. She has survived for 53 months since the start of treatment, without new metastatic lesions or relapse of the thoracic lesions. The male patient has survived for 37 months without new metastatic lesions or relapses. Concurrent chemoradiotherapy in which radiotherapy is applied to both the brain and thoracic lesions may be effective for patients with NSCLC with metastases to the brain only.

Approach to a Patient with Multiple Lung and Brain Carcinomas

“…CT and/or MRI has detected such lesions; which would previously have been subclinical (5). The addition of radiotherapy to surgery did not have an impact on survival but decreased recurrence from 70% to 18% (8). In our case; after the radiotherapy, the brain lesion was not changed.…”

Prognostic Impact of Radiation Therapy to the Primary Tumor in Patients With Non-small Cell Lung Cancer and Oligometastasis at Diagnosis

“…Several studies have shown that patients with oligometastasis may benefit from aggressive therapy (13, 14). One such study (14) showed a substantial OS benefit for patients with a solitary brain metastasis who received treatment to the primary site compared with patients who did not receive this treatment, with corresponding median OS times of 15.5 months and 5.9 months.…”

Systemic chemotherapy after cranial irradiation in patients with brain metastases from non-small cell lung cancer: A retrospective study

“…Although the presence of BM in patients with NSCLC is generally associated with a poor prognosis, prolonged survival has been observed in subgroups of patients with favorable prognostic factors [5,10,11]. Several studies have reported that some patients might benefit from aggressive therapy including surgery, chemotherapy, and radiation therapy [12][13][14].…”