Primary chemotherapy for newly diagnosed non-small-cell lung cancer patients with brain metastases compares well with initial whole-brain radiotherapy, according to researchers.

Primary chemotherapy for newly diagnosed non-small-cell lung cancer patients with synchronous brain metastases compares well with initial whole-brain radiotherapy (WBRT), according to Korean researchers.

In the July 1st issue of Cancer, Dr. Jin Soo Lee and colleagues at the National Cancer Center, Gyeonggi note that WBRT is often the primary approach in such patients and systemic chemotherapy has been considered to be of limited value.

To investigate further, the researchers examined outcome after 40 months in 48 patients who were randomized to primary chemotherapy followed by WBRT or to WBRT followed by chemotherapy.

The response rate in the primary chemotherapy group was 28.0 per cent, not significantly different from the 39.1 per cent in the WBRT-first group. Corresponding progression-free survival was 3.6 and 4.4 months, and overall survival was 9.1 and 9.9 months.

However, grade three or four neutropenia was seen in 79 per ent of the WBRT-first patients versus 40 per cent of the primary chemotherapy group.

Moreover, two of the WBRT-first patients deteriorated to an extent that they could not go on to chemotherapy and another two died within four weeks of WBRT completion.
"Based on this trial," Dr. Lee told Reuters Health, "patients with brain metastases could be treated with systemic chemotherapy alone. In addition, whole brain radiation therapy may be reserved for future use as long as the brain metastases are controlled with systemic chemotherapy."

The researchers also point out that patients "might benefit from primary chemotherapy in terms of toxicity and quality-of-life parameters when compared with the conventional WBRT-first approach."

Cancer 2008;113:143-149