[VPC regimen combined with whole-brain radiotherapy in the treatment of small cell lung cancer with brain metastasis].
摘要
BACKGROUND: The main treatment strategy of cancer patients with brain meta- stasis is irradiation, while so far there is few research concerning chemotherapy combined with radiotherapy for these patients. The aim of this study is to evaluate the therapeutic effect and toxicity of chemotherapy with VPC regimen combined with whole-brain radiotherapy (WBRT) in small cell lung cancer (SCLC) with brain metastasis. METHODS: A total of 60 SCLC patients with brain metastasis received a cycle of VPC regimen (teniposide 60mg/m² iv on days 1-5, cisplatin 35mg/m² iv on days 1-3, semustine 80mg/m² PO on day 1) every 3-4 weeks. WBRT was administered on day 6 of the first cycle of chemotherapy at a dose of 2Gy given in 5 fractions per week. Patients with less than 3 brain lesions received WBRT at a dose of 30Gy and then small field radiotherapy up to total dose of 50Gy, otherwise they received WBRT at a total dose of 40Gy. Response was evaluated by brain and chest CT or MRI after WBRT and at least 2 cycles of chemotherapy were completed. RESULTS: All the patients completed WBRT combined with chemotherapy. Total response rate of primary pulmonary tumor was 46.7%, with 4 cases of CR. The objective brain response rate was 60.0%, with 11 cases of CR and 25 cases of PR. Symptom relief was observed in all 48 patients with neurological symptoms. Main adverse effects were myelotoxicity, nausea/vomiting, constipation and alopecia. The follow-up rate was 93.3% with a median survival duration of 11.3 months. The 1-, 2- and 5-year survival rate was 43.3%, 35.0% and 6.7%, respectively. CONCLUSIONS: Chemotherapy combined with WBRT can be safely performed for SCLC with brain metastasis and its short-term response is quite satisfactory. It may be worthy of further clinical investigation.