PROSPECTIVE EVALUATION OF THE EFFECT ON INITIAL BRAIN METASTASES FROMSMALL-CELL LUNG-CANCER OF PLATINUM-ETOPOSIDE BASED INDUCTION CHEMOTHERAPY FOLLOWED BY AN ALTERNATING MULTIDRUG REGIMEN

Background: During the 1980s reports describing the effect of systemic chemotherapy on brain metastases from chemosensitive tumours emerged, including a few retrospective reports on small cel lung cancer (SCLC) patients. Design: Previously untreated SCLC patients with no other ma lignancy, but in some cases with mixed histological subtype, who had s ymptomatic brain metastases verified by contrast enhanced CT-scan, wer e treated with a multidrug combination chemotherapy regimen and no cra nial irradiation. Radiotherapy was optional at cranial relapse or prog ression at the discretion of the physician in charge. The intracranial effect was evaluated by 4-weekly CT-scan and neurological examination , according to a standardized scoring system. End points: Intracranial response, duration of response, neurological score, terminal CNS stat us, and survival. Results: 21 patients were included, corresponding to 8.6% of consecutive SCLC patients at our institution. 8 patients died before follow-up leaving 13 evaluable for response. In the former gro up, all patients had WHO performance status of 3-4 compared to 6/13 in the latter group. Of the 13 evaluable patients, 1 had early progressi on in the CNS and 1 had no change. 11 had CT-scan verified response, w ith a median duration of 135 days. Most patients, including all comple te responders, had improvement in their neurological score. 6 out of 1 1 responders died without active CNS disease. The crude median surviva l was 111 days, whereas the median survival (early deaths excluded) wa s 197 days. Conclusion: Systemic combination chemotherapy was effectiv e for palliation of initial brain involvement in the majority of patie nts in a small consecutive series. The role of consolidating cranial i rradiation in responders should be assessed by a randomized trial.