Our Radiotherapy Results in Patients with Primary Non-Small Cell Lung Cancer with Brain Metastases

Year 2023, Volume: 18 Issue: 1, 1 - 8, 16.03.2023

Feryal Karaca Selahattin Menteş Ali Arslan Mustafa Emre Saraç Sıddık Keskin Timuçin Çil

https://doi.org/10.17517/ksutfd.978809

Abstract

Objective: Lung cancer is the most common cancer worldwide and is among the leading causes of cancer death. The aim of this study is to examine the survival of patients who received radiotherapy for the brain metastases, whose primary is non-small cell lung cancer, and also determine the factors that are like to affect the survival and to examine the results of radiotherapy in these patients as well.
Materials and Methods: This study included 99 patients with primary non-small cell lung cancer. All patients with brain metastases received radiotherapy. The patients were grouped and compared according to the number of brain metastases, whether surgery was performed for brain metastasis, gender, pathology and stage of the primary focus, visceral organ involvement, and ECOG performance status after brain metastasis developed.
Results: The change in survival rate according to the number of brain metastases at the time of diagnosis was found statistically significant (p<0.01). When the stages and survival of the patients at the time of diagnosis were compared, it was statistically significant (p<0.01). Similarly, the differences among the ECOG/PS status was also statistically significant (p<0.01). When patients with visceral organ metastases were divided into two groups as to groups as dead and alive, it was observed that the number of exitus that most of the patients were lost to their metastatic state (p<0.001).
Conclusion: Age, gender, the number of brain metastases the number of brain metastases brain metastasis, surgery, ECOG/PS, chemotherapy, radiotherapy and visceral organ metastasis were found to be factors affecting survival in patients with brain metastases.

Keywords

Lung Cancer, Brain metastasis, Radiotherapy

Primeri Küçük Hücreli Dışı Akciğer Kanseri Olan Beyin Metastazlı Hastalarda Radyoterapi Sonuçlarımız

Abstract

Amaç: Akciğer kanseri, dünya çapında en sık görülen kanserdir ve kanser ölümlerinin önde gelen nedenleri arasındadır. Bu çalışmada amaç; beyin metastazları nedeniyle radyoterapi alan, primeri küçük hücreli dışı akciğer kanseri olan hastalarda radyoterapi etkilerini, sağkalımları ve sağkalımı etkileyebilecek faktörleri araştırmaktır.
Gereç ve Yöntemler: Bu çalışmaya primer küçük hücreli dışı akciğer kanserli 99 hasta dâhil edildi. Beyin metastazı olan tüm hastalara radyoterapi uygulandı. Hastalar, beyin metastazı sayısı, beyin metastazı için ameliyat yapılıp yapılmadığı, cinsiyet, patoloji ve primer odak evresi, viseral organ tutulumu ve beyin metastazı sonrası ECOG performans durumuna göre gruplara ayrıldı ve gruplar kendi içinde karşılaştırıldı.
Bulgular: Tanı anındaki beyin metastaz sayısına göre sağkalım oranındaki değişim istatistiksel olarak anlamlı bulundu (p<0.01). Hastaların tanı anındaki evresine göre sağkalım karşılaştırıldığında istatistiksel olarak anlamlı fark bulundu (p<0.01). Benzer şekilde ECOG/PS durumuna göre sağ kalım oranındaki değişim istatistiki olarak anlamlı bulundu (p<0.01). Visseral organ metastazı olan hastalar kendi aralarında yaşayanlar ve yaşamayanlar olarak iki gruba ayrıldığında yaşamayan hasta sayısının yüksek olduğu gözlendi (p<0.001).
Sonuç: Beyin metastazı gelişmiş hastalarda; yaş, cinsiyet, beyin metastaz sayısı, cerrahi, ECOG/PS, kemoterapi, radyoterapi ve viseral organ metastazının sağkalımı etkileyen faktörler olduğu bulunmuştur.

Keywords

akciğer kanseri, beyin metastazı, radyoterapi

References

• Howlader N, Noone AM, Krapcho M, Garshell J, Miller D, Altekruse SF, et al. SEER Cancer Statistics Review, 1975-2011, National Cancer Institute. Bethesda, MD, https://seer.cancer.gov/archive/csr/1975_2011/
• Hellman S, Weichselbaum RR. Oligometastases. J Clin Oncol. 1995;13:8–10.
• Plönes T, Dango S, Brugger W, Ludwig C, Stoelben E. Potentially curative surgical therapy in oligometastatic nonsmall cell lung cancer. Dtsch Med Wochenschr. 2014;139(11):538–542.
• Ashworth A, Rodrigues G, Boldt G, Palma D. Is there an oligometastatic state in non-small cell lung cancer? A systematic review of the literature. Lung Cancer. 2013;82:197–203.
• Barnholtz-Sloan JS, Sloan AE, Davis FG, Vigneau FD, Lai P, Sawaya RE. Incidence proportions of brain metastases in patients diagnosed (1973 to 2001) in the Metropolitan Detroit Cancer Surveillance System. J Clin Oncol. 2004;22:2865–2872.
• Welsh JW, Komaki R, Amini A, Munsell MF, Unger W, Allen PK et al. Phase II trial of erlotinib plus concurrent whole-brain radiation therapy for patients with brain metastases from non-small-cell lung cancer. J Clin Oncol. 2013;31:895–902.
• Davey P, Hoegler D, Ennis M, Smith J. A phase III study of accelerated versus conventional hypofractionated whole brain irradiation in patients of good performance status with brain metastases not suitable for surgical excision. Radiother Oncol. 2008;88:173–176.
• Grossi F, Kubota K, Cappuzzo F, d Mrinis F, Gridelli C, Aita M et al. Future scenarios for the treatment of advanced non-small cell lung cancer: Focus on taxane-containing regimens. Oncologist. 2010;15:1102–1112.
• Sundstrom JT, Minn H, Lertola KK, Nordman E. Prognosis of patients treated for intracranial metastase with whole-brain irradiation. Ann Med. 1998;30:296-299.
• Gaspar L, Scott C, Rotman M, Asbell S, Phillips T, Wasserman T et al. Recursive partitioning analysis (RPA) of prognostic factors in three Radiation Therapy Oncology Group (RTOG) brain metastases trials. Int J Radiat Oncol Biol Phys. 1997;37:745-754.
• Patchell RA, Regine WF. The rationale for adjuvant whole brain radiation therapy with radiosurgery in the treatment of single brain metastases. Technol Cancer Res Treat.2003;2:111-115.
• Arbit E, Wronski M, Burt M, Galicich JH. The treatment of patients with recurrent brain metastases: A retrospective analysis of 109 patients with nonsmall cell lung cancer. Cancer. 1995;76:765-773.
• Wen PY, Loeffler JS. Management of brain metastases. Oncology (Huntingt). 1999;13:941.
• Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL. AJCC Cancer Staging AJCC Cancer Staging Manual, 7th. Edition. New York: Springer; 2010.
• Herbst RS, Heymach JV, Lippman SM. Lung cancer. N Engl J Med. 2008;359(13):1367–1380.
• Gouvinhas C, De Mello RA, Oliveira D, Castro-Lopes JM, Castelo-Branco P, dSantos RS et al. Lung cancer: a brief review of epidemiology and screening. Future Oncol. 2018;14(6):567–575.
• Canda T, Canda MŞ, Akkoçlu A, Akpınar O, Koyuncuoğlu M. Akciğerin small cell karsinomunda prognostik faktörlerin araştırılması. Ege Tıp Dergisi. 1991;30:192-197.
• Özbay B, Dereli MŞ, Akın M, Ceylan S. Primer akciğer kanserli 173 olguda tedavi ve prognoz. Ege Tıp Dergisi. 1991;30:458-460.
• Sevgi E, Akkurt İ, Özşahin S, Ardıç S, Altınörs M, Dayıcan B et al. A retrospective Analysıs of 189 patients with lung cancer. Turkiye Klinikleri J Med Sci. 1997;17:191-199.
• Yin J, Li Y, Zhao H, Qin Q, Li X, Huang J et al. Copy‐number variation of MCL1 predicts overall survival of non‐small‐cell lung cancer in a Southern Chinese population. Cancer Medicine May. 2016:10.1002.
• Fink KR, Fink JR. Imaging of brain metastases. Surg Neurol Int. 2013;4(Suppl 4):209–219.
• Tong, McCullagh KL, Iv M. Advanced imaging of brain metastases: From augmenting visualization and improving diagnosis to evaluating treatment response. Frontiers in Neurology. 2020;11:1-14.
• Dong K, Liang W, Zhao S, Guo M, He Q, Li C et al. .EGFR-TKI plus brain radiotherapy versus EGFR-TKI alone in the management of EGFR-mutated NSCLC patients with brain metastases. Transl Lung Cancer Res. 2019;8(3):268-279.
• Patchell R.A, Tibbs P.A, Walsh J.W, Dempsey R, Maruyama Y, Kryscio R.J et al. A randomized trial of surgery in the treatment of single metastases to the brain. New Engl. J. Med. 1990;322:494-500.
• Rotta JM, Rodrigues DB, Diniz JM, Abreu BM, Kamimura F, Sousa UO et al. Analysis of survival in patients with brain metastases treated surgically: Impact of age, gender, oncologic status, chemotherapy, radiotherapy, number and localization of lesions, and primary cancer site. Rev Assoc Med Bras. 2018;64(8):717-722.
• Shen Q, Sahin AA, Hess KR, Suki D, Aldape KD, Sawaya R et al. Breast cancer with brain metastases: clinicopathologic features, survival, and paired biomarker analysis. Oncologist. 2015;20(5):466-473.
• Arita H, Narita Y, Miyakita Y, Ohno M, Sumi M, Shibui S. Risk factors for early death after surgery in patients with brain metastases: re-evaluation of the indications for and role of surgery. J Neurooncol. 2014;116(1):145-152.
• Gorovets D, Rava P, Ebner DK, Tybor DJ, Cielo D, Puthawala Y et al. Predictors for long-term survival free from whole brain radiation therapy in patients treated with radiosurgery for limited brain metastases. Front Oncol.2015;5:110.8.
• Noordijk EM, Vecht CJ, Haaxma-Reiche H, Padberg GW, Voormolen JH, Hoekstra F.H et al. The choice of treatment of single brain metastasis should be based on extracranial tumor activity and age. Int. J. Radiat. Oncol. Biol. Phys.1994;29:711-717.
• Nieder C, Andratschke N, Grosu AL, Molls M. Recursive partitioning analysis (RPA) class does not predict survival in patients with four or more brain metastases. Strahlenther Onkol.2003;179:16–20.
• He ZY, CLi MF, Lin JH, Lin D, Lin RJ. Comparing the efficacy of concurrent EGFR-TKI and whole-brain radiotherapy vs EGFR-TKI alone as a first-line therapy for advanced EGFR-mutated non-small-cell lung cancer with brain metastases: a retrospective cohort study. Cancer Management and Research. 2019:11;2129–2138.
• Ji Z, Bi N, Wang J, Hui Z, Xiao Z, Feng Q et al. Risk factors for brain metastases in locally advanced non-small cell lung cancer with definitive chest radiation .Int J Radiation Oncol Biol Phys. 2014;89/2:330-337.
• Doı H, Nakamatsu K, Anamı S, Fukuda K, Inada M, Tatebe H et al. Neutrophil–to–Lymphocyte Ratio predicts survival after whole-brain radiotherapy in non-small cell lung cancer. In Vivo. 2019;33:195-201.
• Ceresoli GL, Reni M, Chiesa G, Carretta A, Schipani S, Passoni P et al. Brain metastases in locally advanced nonsmall cell lung carcinoma after multimodality treatment: risk factors analysis. Cancer. 2002;95:605-612.
• Dimitropoulos C, Hillas G, Nikolakopoulou S, Nikolakopoulou S, Kostara L,Sagris K et al. Prophylactic cranial irradiation in non-small cell lung cancer patients: Who might be the candidates? Cancer Manag Res. 2011;3:287-294.
• Keith B, Vincent M, Stitt L, Tomiak A, Malthaner R, Yu E et al. Subsets more likely to benefit from surgery or prophylactic cranial irradiation after chemoradiation for localized non-small-cell lung cancer. Am J Clin Oncol. 2002;25:583-587.
• McWilliams RR, Rao RD, Brown PD, Link MJ, Buckner JC. Treatment options for brain metastases from melanoma. Exp Rev Anticancer Ther. 2005;5:809–820.
• Sawaya R, Bindal R, Lang FF. Metastatic brain tumors. In: Kaye AH, Laws EE, editors. Brain tumors. New York: Churchill-Livingstone; 2001. p:99–1026.
• Langley RR, Fidler IJ. Tumor cell-organ microenvironment interactions in the pathogenesis of cancer metastasis. Endocr Rev. 2007;28:297–321.
• Kakiuchi S, Daigo Y, Tsunoda T, Yano S, Sone S, Nakamura Y. Genome-wide analysis of organ-preferential metastasis of human small cell lung cancer in mice. Mol Cancer Res. 2003;1:485–499.
• Gandara DR, Chansky K, Albain KS, Gaspar LE, Lara Jn PR, Kelly K et al. Long-term survival with concurrent chemoradiation therapy followed by consolidation docetaxel in stage IIIB non–small-cell lung cancer: A Phase II Southwest Oncology Group Study (S9504). Clinical Lung Cancer. 2006;8(2):116-121.
• Ali A, Goffin JR, Arnold A, Ellis PM. Survival of patients with non-small-cell lung cancer after a diagnosis of brain metastases. Curr Oncol. 2013;20:300-306.