Risk factors for brain metastases after definitive chemoradiation for locally advanced non-small cell lung cancer

Abstract

Background/Aim. As therapy for locally advanced nonsmall cell lung carcinoma (NSCLC) improves, brain metastases (BM) still remain a great problem. The aim of the study was to analyze risk factors for BM in patients with locally advanced NSCLC after chemoradiation therapy. Methods. Records for 150 patients with non-resectable stage IIIA/IIIB NSCLC treated with combined chemoradiation therapy were analyzed. All of them had negative brain metastases imaging result before the treatment. Incidence of BM was examined in relation to age, sex, histological type, stage, performance status scale of wellbeing of cancer patients, weight loss, chemotherapy regimen and chemotherapy timing. Results. One- and 2-year incidence rates of BM were 19 and 31%, respectively. Among pretreatment parameters, stage IIIB was associated with a higher risk of BM (p < 0.004) vs stage IIIA. Histologically, the patients with nonsquamous tumors had an exceptionally high 2-year BM risk rate of 32% (p < 0.02). Examining treatment-related parameters, 1-year and 2-year actuarial risk of BM were 27 and 39%, respectively, in the patients receiving chemotherapy before radiotherapy and 15 and 20%, respectively, when radiotherapy was not delayed (p < 0.03). On multivariate analysis, timing of chemotherapy (p < 0.05) and stage IIIA vs IIIB (p < 0.01) remained statistically significant. Conclusion. Patients with IIIB stage, nonsquamous NSCLC, particularly those receiving sequential chemotherapy, had significantly high BM rates.Uvod/Cilj. Dok se terapija za lokalno odmakli nemikrocelularni karcinom pluca (NSCLC) poboljsava, metastaze u mozgu ostaju veliki problem. Cilj ove studije bio je analiza faktora rizika od pojave metastaza u mozgu kod bolesnika sa lokalno odmaklim NSCLC nakon hemio-zracne terapije. Metode. Analizirani su podaci 150 bolesnika sa neresektabilnim IIIA/ IIIB stadijumom NSCLC lecenih kombinovanom hemio i zracnom terapijom. Svi bolesnici bili su bez metastaza u mozgu pre lecenja. Ucestalost metastaza u mozgu ispitivana je u zavisnosti od starosti, pola, histoloskog tipa, stadijuma bolesti, 'performans' status skale za procenu kvaliteta zivota bolesnika sa neoplazmom, gubitka telesne tezine, hemioterapijskog protokola i redosleda primene. Rezultati. Jednogodisnja i dvogodisnja incidencija mozdanih metastaza bila je 19 i 31%. Stadijum IIIB bio je povezan sa visokim rizikom mozdanih metastaza (p < 0,004) u odnosu na stadijum IIIA. Histoloski, bolesnici sa neskvamocelularnim tumorom izlozeni su znacajnom riziku od pojave metastaza u mozgu tokom dvogodisnjeg perioda (32%) (p < 0,02). Ispitivanjem terapijskih parametara, jednogodisnji i dvogodisnji rizik od pojave mozdanih metastaza kod bolesnika koji su primali hemioterapiju pre radioterapije, iznosio je 27 i 39%, odnosno 15 i 20% kod bolesnika kod kojih radioterapija nije bila odlozena (p < 0,03). Multivarijantnom analizom, vreme za hemioterapiju (p < 0,05) i stadijum IIIA u odnosu na IIIB (p < 0,01) bili su statisticki znacajni. Zakljucak. Bolesnici sa stadijumom IIIB neskvamocelularnog karcinomoma i sekvencionalnom hemioterapijom imaju znacajno visu stopu mozdanih metastaza.