BRAIN RELAPSES IN CHEMOTHERAPY-TREATED SMALL-CELL LUNG-CANCER - A RETROSPECTIVE REVIEW OF 2 TIME-DOSE REGIMENS OF THERAPEUTIC BRAIN IRRADIATION

The incidence of brain metastases secondary to small cell lung cancer (SCLC) is about 35% and the treatment strategy of brain irradiation wi th respect to dose and fractionation is controversial. In order to eva luate treatment outcome of brain irradiation in SCLC patients with bra in relapse, we retrospectively evaluated all patients treated with bra in irradiation in the eastern part of Denmark from 1988 to 1992 (PCI p atients excluded). During this 5-year period, 101 evaluable patients w ere included (44 females, 57 males) (median age 61 years; range, 39-75 years). Forty-four patients, of whom 43 were in extracerebral complet e remission (CR), received extended course (EC) brain irradiation (> 4 5 Gy, treatment schedule > 4 weeks). Fifty-seven patients received sho rt course (SC) brain irradiation (< 30 Gy, treatment schedule < 1 week ). Among the SC treated patients, 14 were in CR, 20 had partial remiss ion or stable disease and 23 had progressive extracerebral disease. Th e median survival (from diagnosis of brain metastases) in the group re ceiving irradiation with EC (44 patients) was 160 days (range, 74-2021 days), while the 57 patients treated with SC had a median survival of 88 days (range, 20-948 days) (P = 0.00001, Log-Rank analysis). In a s ubgroup of 14 patients in extracerebral CR, receiving SC irradiation, the median survival was 83 days (range, 15-948 days). When the latter patients were compared to the 43 patients in CR in the group treated w ith EC, a statistically significant difference was shown (P 0.034, Log -Rank analysis). Using Cox-hazard regression analysis with backward el imination, liver metastases and poor performance status were adverse p rognostic signs, although the only significant parameters of survival were gender (female vs. male, relative risk of dying 1 and 1.52, P = 0 .05) and schedule of brain irradiation (extended course vs. short cour se, relative risk of dying, 0.36 and 1, P < 0.001). Extended course ir radiation of brain relapse secondary to SCLC seems in general to be of limited value, although a significant prolonged survival at approxima tely 7 weeks, was obtained. The prolongation of survival does not seem worthwhile considering the length of treatment time (5-6 weeks) compa red to SC treatment (1 week). However, the data do not permit evaluati on of the quality of life of the patients. This retrospective evaluati on suggests the need for randomized trials with carefully planned qual ity-of-life assessments.