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

Kim, Jung Han; Kim, Hyeong Su; Kwon, Jung Hye; Park, Sarah; Kim, Ho Young; Jung, Joo Young; Kim, Hyo Jung; Song, Hun Ho; Lee, Gyeong‐Won; Lee, Soon Il; Gong, Soo Jung; Lee, Jung-Ae; Kim, Kyoung Ju; Zang, Dae Young

doi:10.1016/j.lungcan.2008.06.002

Cited by 11 publications

(8 citation statements)

References 21 publications

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“…Survival for the different management strategies was within the range of previously reported results [8,9]. This is also true for patients who received systemic chemotherapy (7 months as in the retrospective non-small cell lung cancer study by Kim et al [6] and the subgroup analysis of a prospective phase III trial by Edelman et al [10] in the same cancer type). As this was not a randomized trial, our data do not prove the superiority of surgical resection over RT or systemic treatment over none.…”

Section: Discussionsupporting

confidence: 81%

“…As survival depends on disease control both intra- and extracranially, patients with active extracranial disease might also be candidates for systemic treatment. Emerging evidence suggests that systemic treatment might have an impact on survival, but well-designed large-scale randomized trials are lacking [3,4,5,6]. It is also uncertain what levels of toxicity and cost of therapy, which vary tremendously with different management attitudes, are justified in patients with brain metastases as many of them receive active treatment in the terminal phase of their disease.…”

Section: Introductionmentioning

confidence: 99%

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Resource Utilization in Patients with Brain Metastases Managed with Best Supportive Care, Radiotherapy and/or Surgical Resection: A Markov Analysis

et al. 2010

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Objective: In spite of the large number of patients and increasing financial pressure on health care budgets worldwide, limited data on resource utilization after diagnosis of brain metastases are available. Methods: Prospective data were collected on all patients diagnosed with brain metastases during a time period of 2 years (n = 53). Treatment was best supportive care (BSC), primary radiotherapy (RT) and/or surgical resection. Eighty-five percent of patients had active extracranial disease. Costs were calculated from the hospital and nursing home’s point of view. Results: Overall, 11,532 patient days were analyzed. Treatment per patient amounted to 0.8 courses of whole-brain RT, 0.2 neurosurgical procedures, 0.1 radiosurgical procedures and 1.3 cycles of chemotherapy. Median survival in the BSC, RT and neurosurgery groups was 1.4, 4.6 and 11.0 months, respectively. Chemotherapy was associated with longer median survival. Four percent of the remaining lifetime was spent in nursing homes and 8% within hospitals. Forty-three percent of all hospital days and 47% of deaths were related to non-neurologic causes. The total cost per patient was 24,649 EUR (34,841 USD) and the corresponding cost per life year was 43,955 EUR (62,130 USD). Hospital care was the main cost factor. Conclusions: A considerable amount of resources is utilized in this patient group. Better tools for avoiding overtreatment and selecting patients for appropriate therapy are needed to achieve maximum value for money.

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Section: Discussionsupporting

confidence: 81%

Section: Introductionmentioning

confidence: 99%

Resource Utilization in Patients with Brain Metastases Managed with Best Supportive Care, Radiotherapy and/or Surgical Resection: A Markov Analysis

et al. 2010

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“…It was recently suggested that systemic control after BM could be beneficial for selected patients with breast or lung cancer [10,18] because not only complications of BM but also systemic disease progression affected survival or the quality of life of patients whose BM had been treated with local modalities. In the present study, 34 patients (29%) were treated with systemic chemotherapy after local control of BM.…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, adjuvant WBRT or chemotherapy, administered after surgery or RS, is commonly used in practice for local and systemic control. Recently reported data suggest that chemotherapy can increase survival among patients treated with cranial irradiation for BM associated with non-small cell lung carcinoma [10] and breast cancer [11], dependent upon specific prognostic indicators and the biologic subtype of the cancer.…”

Section: Introductionmentioning

confidence: 99%

Characteristics and prognosis of patients with colorectal cancer-associated brain metastases in the era of modern systemic chemotherapy

et al. 2011

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Brain metastases (BM) occur in approximately 20-40% of cancer patients. The present study investigated the clinical outcomes of patients with BM from colorectal cancer (CRC) to assess the benefit of systemic chemotherapy (CT) administered after surgical or radiotherapeutic control of BM and to identify independent prognostic factors associated with survival after BM. Between August 2001 and July 2009, 118 patients with symptomatic BM from CRC received either cranial irradiation or craniotomy at two large cancer centers in South Korea. Retrospective review and statistical analysis of clinical characteristics and outcomes were performed for all patients. Median time from diagnosis of metastatic CRC to detection of BM was 12.2 months (range 0-76.2 months). Thirteen patients (11%) exhibited brain involvement at initial presentation. Median survival after BM development was 4.1 months [95% confidence interval (CI) 3.3-4.9 months]. Forty-six patients (40%) had been treated previously with the chemotherapeutic agents fluoropyrimidine, oxaliplatin, and irinotecan. Patients who received CT after BM exhibited significantly improved survival compared with those who did not (12.4 versus 3.1 months, respectively; P < 0.001). Multivariate analysis revealed that CT intervention after presentation with BM was significantly associated with survival after BM, and the adjusted hazard ratio was 0.30 (95% CI 0.17-0.51, P < 0.001). Although BM is a late-stage phenomenon in CRC, approximately two-thirds of patients were still unexposed to irinotecan or oxaliplatin at the development of BM in our study. Thus, additional chemotherapeutic intervention after BM associated with CRC may be beneficial for selected patients.

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“…Pemetrexed monotherapy has demonstrated moderate efficacy and good safety in chemotherapy-naïve ECOG performance status (PS) 2 patients with EGFR wild-type or unknown advanced non-squamous NSCLC [13]. In most cases, patients with BM can only receive 1 cycle or less of chemotherapy due to early death, rapid progression, clinical impairment, or toxicity, and these rapid deteriorations are especially frequent in patients with ECOG PS 2 [14]. Despite front-line treatment activity, treatment of recurrent/progressive BM is more controversial, especially for patients with neurological symptoms and poor performance status where no further treatment (supportive care) is recommended [15].…”

Section: Discussionmentioning

confidence: 99%

Response of brain metastasis from lung cancer patients to an oral nutraceutical product containing silibinin

et al. 2016

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Despite multimodal treatment approaches, the prognosis of brain metastases (BM) from non-small cell lung cancer (NSCLC) remains poor. Untreated patients with BM have a median survival of about 1 month, with almost all patients dying from neurological causes. We herein present the first report describing the response of BM from NSCLC patients to an oral nutraceutical product containing silibinin, a flavonoid extracted from the seeds of the milk thistle. We present evidence of how the use of the silibinin-based nutraceutical Legasil® resulted in significant clinical and radiological improvement of BM from NSCLC patients with poor performance status that progressed after whole brain radiotherapy and chemotherapy. The suppressive effects of silibinin on progressive BM, which involved a marked reduction of the peritumoral brain edema, occurred without affecting the primary lung tumor outgrowth in NSCLC patients. Because BM patients have an impaired survival prognosis and are in need for an immediate tumor control, the combination of brain radiotherapy with silibinin-based nutraceuticals might not only alleviate BM edema but also prove local control and time for either classical chemotherapeutics with immunostimulatory effects or new immunotherapeutic agents such as checkpoint blockers to reveal their full therapeutic potential in NSCLC BM patients. New studies aimed to illuminate the mechanistic aspects underlying the regulatory effects of silibinin on the cellular and molecular pathobiology of BM might expedite the entry of new formulations of silibinin into clinical testing for progressive BM from lung cancer patients.

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

Cited by 11 publications

References 21 publications

Resource Utilization in Patients with Brain Metastases Managed with Best Supportive Care, Radiotherapy and/or Surgical Resection: A Markov Analysis

Resource Utilization in Patients with Brain Metastases Managed with Best Supportive Care, Radiotherapy and/or Surgical Resection: A Markov Analysis

Characteristics and prognosis of patients with colorectal cancer-associated brain metastases in the era of modern systemic chemotherapy

Response of brain metastasis from lung cancer patients to an oral nutraceutical product containing silibinin

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