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Time From Treatment to Subsequent Diagnosis of Brain
Metastases in Stage III Non-Small-Cell Lung Cancer: A Retrospective Review
by the Southwest Oncology Group
Gaspar LE, Chansky K, Albain KS, Vallieres E, Rusch V, Crowley JJ,
Livingston RB, Gandara DR
MBA, University of Colorado Health Sciences Center, Department of Radiation
Oncology, 1665 N Ursula St, Box F-706, Ste 1032, Aurora, CO 80010-0510;
e-mail: laurie.gaspar@uchsc.edu.
Purpose. A retrospective review of the Southwest Oncology Group (SWOG)
database was undertaken to review the incidence and timing of diagnosis of
brain metastases in patients undergoing combined-modality therapy for stage
III non-small-cell lung cancer (NSCLC).
Patients and Methods. Four hundred
twenty-two eligible, assessable patients with stage IIIA/B NSCLC were
treated on four SWOG protocols.
Treatment varied with protocol but consisted
of concurrent cisplatin-etoposide and radiation in all patients, with a
surgery arm in two of the four protocols.
Results. Of the 422 total patients,
268 (64%) have experienced disease progression; 54 relapses (20%) were in
brain only, 17 (6.5%) were in brain and other sites simultaneously, and 197
(63.5%) were in sites other than brain.
Of the 268 patients with disease
progression, progression in the brain only, in the brain and other sites,
and not in the brain occurred in 20%, 6%, and 74% of patients, respectively.
Time from treatment to diagnosis of disease progression in the brain in 71
patients was as follows: during treatment, 16 relapses (22.5%); 0 to 16
weeks after treatment, 17 relapses (24%); 16 weeks to 6 months after
treatment, 10 relapses (14%); 6 to 12 months after treatment, 16 relapses
(22.5%); and more than 12 months after treatment, 12 relapses (17%).
Nonsquamous histology and young patient age were the only significant
predictors for increased risk of early relapse with brain metastases.
Conclusion. Brain metastases often develop early in the course of treatment
for stage IIIA/B NSCLC.
The statistical designs of ongoing trials of
prophylactic cranial irradiation in stage III NSCLC have taken this into
account.
PMID: 15860851 [PubMed - in process]
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