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Seizure prophylaxis in
patients with brain metastases from solid tumors: Is phenytoin necessary?
S. Evans, N. Jooma, A. Kabir, L. Nedzi, E. Zakris, R. Mudad
Tulane University Hospital & Clinic, New Orleans, LA
Background.
The use of phenytoin as primary seizure prophylaxis in
patients with brain metastases from solid tumors is widely practiced at our
institution, although this has fallen out of favor in the literature.
There are concerns over p450 interactions between phenytoin and standard
chemotherapy regimens.
We sought to determine the incidence of seizures in patients with brain
metastases with or without prophylaxis, as well as the percentage of those
patients receiving chemotherapy.
Methods.
We performed a retrospective review of patients with brain
metastases from solid tumors from 1997-2002.
Patients were identified through the tumor registries of Tulane affiliated
hospitals.
Cases were excluded if there was no tissue diagnosis, or if there were spinal
cord metastases only.
Demographic information, phenytoin use, prevalence of seizures, date of tissue
diagnosis, date of death, and presenting symptoms were recorded.
All treatments were recorded.
Results.
Eighty-eight patients were identified.
Non-small cell lung carcinoma was the most common histology, representing 79.5%
of patients.
Median overall survival of all patients was 128 days.
Thirty-nine patients received prophylactic phenytoin, and of those, twenty-one
patients (51%) subsequently developed seizures.
Forty-seven patients (53%) were not on phenytoin and four (8.5%) subsequently
developed seizures.
Thirteen patients (32%) received phenytoin and chemotherapy, while ten patients
(21%) received chemotherapy alone.
Median survival in the former group was 267 days, while in the latter it was 120
days.
Conclusions.
Paradoxically, seizure development was more common in the
group receiving phenytoin, indicating that primary prophylaxis was ineffective,
and may not be necessary.
Data on neurosurgical intervention in both groups, possibly explaining the
difference, will be analyzed and reported at the meeting.
Survival differences between the chemotherapy groups will also be analyzed to
evaluate its statistical significance.
Copyright 2004 American Society of Clinical Oncology All rights
reserved worldwide.
Source: http://www.asco.org/ac/1,1003,_12-002636-00_18-0026-00_19-00585,00.asp
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