Prospective evaluation of the effect on initial brain metastases from small cell lung cancer of platinum-etoposide based induction chemotherapy followed by an alternating multidrug regimen

Abstract

Background: During the 1980s reports describing the effect of systemic chemotherapy on brain metastases from chemosensitive tumours emerged, including a few retrospective reports on small cell lung cancer (SCLC) patients. Design: Previously untreated SCLC patients with no other malignancy, but in some cases with mixed histological subtype, who had symptomatic brain metastases verified by contrast enhanced CT-scan, were treated with a multidrug combination chemotherapy regimen and no cranial irradiation. Radiotherapy was optional at cranial relapse or progression at the discretion of the physician in charge. The intracranial effect was evaluated by 4-weekly CT-scan and neurological examination, according to a standardized scoring system. End points: Intracranial response, duration of response, neurological score, terminal CNS status, and survival. Results: 21 patients were included, corresponding to 8.6% of consecutive SCLC patients at our institution. 8 patients died before follow-up leaving 13 evaluable for response. In the former group, all patients had WHO performance status of 3-4 compared to 6/13 in the latter group. Of the 13 evaluable patients, 1 had early progression in the CNS and 1 had no change. 11 had CT-scan verified response, with a median duration of 135 days. Most patients, including all complete responders, had improvement in their neurological score. 6 out of 11 responders died without active CNS disease. The crude median survival was 111 days, whereas the median survival(early deaths excluded) was 197 days. Conclusion: Systemic combination chemotherapy was effective for palliation of initial brain involvement in the majority of patients in a small consecutive series. The role of consolidating cranial irradiation in responders should be assessed by a randomized trial. © 1993 Kluwer Academic Publishers.