Central nervous system relapse continues to be a therapeutic challenge in extensive disease small-cell lung cancer patients with initial symptomatic brain metastases and good response to chemoradiotherapy

[Retrospectively Analysis of Factors Influencing the Relapse (or Progression) of Newly Diagnosed Nonoperative Small Cell Lung Cancer]

背景与目的

小细胞肺癌对初始放化疗敏感，但容易复发或转移，生存率低。本研究目的在于探讨初治非手术小细胞肺癌复发/进展的影响因素，并分析复发/进展时间（无进展生存时间）（progression-free survival, PFS）与总生存时间（overall survival, OS）之间的相关性。

方法

回顾性分析182例于2009年1月-2011年12月在上海市胸科医院新诊断的住院并接受化疗联合/不联合放疗后出现复发/进展的非手术小细胞肺癌患者的临床资料，进行单因素和Cox回归多因素分析各种因素对PFS的影响。采用双变量相关分析来分析PFS与OS之间的关系。

结果

单因素分析显示发病时肿瘤TNM分期、是否肝转移、是否脑转移、一线化疗周期数、初始化疗疗效以及是否胸腔放疗对PFS有影响。发病时非脑转移患者中接受预防性颅脑照射（prophylactic cranial irradiation, PCI）与未接受PCI对PFS存在统计学差异。多因素分析表明一线化疗周期数、初始化疗疗效、胸腔放疗与否是影响PFS的独立因素。双变量相关分析显示PFS与OS存在显著正相关。

结论

一线化疗周期数多（大于4次）、初始化疗疗效好（部分缓解或完全缓解）、联合胸腔放疗以及非脑转移者行PCI可延长小细胞肺癌患者的PFS。

Etoposide and Temozolomide in Combination for the Treatment of Progressive Small-Cell Lung Cancer Central Nervous System Metastases: Two Cases

Introduction

Progression of central nervous system (CNS) metastases from small cell lung cancer (SCLC) after radiation therapy is associated with a poor prognosis.

Case reports

We present two cases of patients with progressive CNS metastases from SCLC treated with oral temozolomide and etoposide. Sustained clinical responses and radiographic stability were demonstrated. The palliative chemotherapy regimen was well tolerated.

Discussion

A regimen of oral temozolomide and etoposide for progressive CNS metastases from SCLC is well tolerated and may be associated with sustained stability of disease.

Chemoradiotherapy duration correlates with overall survival in limited disease SCLC patients with poor initial performance status who successfully completed multimodality treatment

BACKGROUND AND PURPOSE

Limited data concerning treatment-related prognostic factors in limited disease (LD) small-cell lung cancer (SCLC) patients with poor initial performance status (PS) who successfully completed chemoradiotherapy (CRT) are available.

PATIENTS AND METHODS

A total of 125 patients with initial PS WHO 2-3 who successfully completed CRT were retrospectively reviewed. Thoracic radiation therapy (TRT) was applied in the concurrent (group 1) or sequential (group 2) mode. Influence of treatment type, time from diagnosis to start of TRT, number of chemotherapy cycles, prophylactic cranial irradiation (PCI), occurrence of brain metastases (BMs), and duration of CRT on overall survival (OS) were analyzed.

RESULTS

Median duration of CRT was 156 days in group 1 and 195 days in group 2 (p < 0.001). Median progression-free survival and OS were 11.6 (95% confidence interval (CI) 10-13.2) and 14.9 (95% CI 11.7-17.6) months with no difference between the groups. The 2- and 3-year survival rates were 37.9 ± 6.9% and 22.7 ± 6.3% in group 1 and 22.4 ± 4.9% and 15.2 ± 4.3% in group 2, respectively. Duration of CRT was only treatment-related factor predicting OS in the uni- (p < 0.014) and multivariate (p < 0.025) analyses. Short dose-dense CRT was associated with improved OS.

CONCLUSION

Duration of CRT affects OS in LD SCLC patients with poor initial performance status who successfully completed multimodality treatment.