Favorable Prognosis of Brain Metastases in Small Cell Lung Cancer

Giannone, Leonard; Johnson, David H.; Hande, Kenneth R.; Greco, F. Anthony

doi:10.7326/0003-4819-106-3-386

Cited by 65 publications

(19 citation statements)

References 7 publications

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“…We cannot comment directly on response duration because the study design included the option of cranial irradiation for patients who had responded to chemotherapy. The policy of chemotherapy as initial treatment for brain metastases has not been compared with initial radiotherapy in a randomised trial, but we have not found evidence of a detriment in survival (Cox et al, 1980;Giannone et al, 1987).…”

Section: Response To Chemotherapymentioning

confidence: 76%

The response of cerebral metastases in small cell lung cancer to systemic chemotherapy

Twelves

Souhami²,

Harper³

et al. 1990

Br J Cancer

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Summary Although small cell lung cancer (SCLC) is very chemosensitive, cerebral metastases are treated with radiotherapy in the belief that they are protected from chemotherapy by the blood-brain barrier (BBB). The validity of this assumption has not been tested in clinical practice. In a randomised trial of treatment in 610 patients with SCLC, 19 patients who had symptomatic cerebral metastases at presentation were treated initially with chemotherapy, and cranial irradiation withheld. (Long et al., 1979). Indeed the increased permeability of tumour vessels to radiolabelled colloids and CT contrast media is fundamental to the radiological diagnosis of cerebral metastases. Despite this, when treating cerebral metastases it is often assumed that, because most cytotoxic drugs do not cross the intact BBB, chemotherapy will be ineffective.Even in SCLC, which is a highly chemosensitive tumour, chemotherapy has been largely ignored in the management of cerebral metastases, these patients being treated with steriods and cranial irradiation (Cox et al., 1980). There are reports of radiologically proven responses of cerebral metastases to systemic chemotherapy in SCLC (Kantarjian et al., 1984;Postmus et al., 1987; Kristiansen & Hansen, 1988) but the response rate to a single regimen is not known. However, the only systematic study of conventional chemotherapy for cerebral metastases (Rosner et al., 1986) showed that cerebral metastases from breast cancer have the same frequency of response as secondary deposits at other sites.Our aim was to assess in a prospective study the objective response rate of cerebral metastases in previously untreated SCLC patients who received uniform chemotherapy, rather than radiotherapy, as initial treatment. MethodsBetween February 1982 and September 1985, 610 patients with histologically or cytologically confirmed SCLC entered a multicentre randomised chemotherapy trial (Spiro et al., 1989). They had no past history of malignancy and had not received previous radiotherapy or chemotherapy. Brain scans were not performed routinely, and only patients with symptoms or signs of cerebral metastases at presentation had a CT or radionuclide brain scan before starting treatment. Cerebral metastases were diagnosed by the presence of enhanced lesions on CT or areas of increased uptake on isotope brain scan, compatible with the clinical findings. In these patients, cranial irradiation was withheld and initial treatment was with chemotherapy. Patients with a severe neurological deficit received oral dexamethasone, but if possible the dose was reduced during the course of chemotherapy. Steroids were not used as anti-emetics. The chemotherapy was cyclophosphamide I g m-2 i.v. day 1, vincristine 2 mg i.v. day I and etoposide 100 mg tds p.o. days 1-3. If possible the CT scan was repeated before the second cycle of chemotherapy, and it was planned that all patients be evaluated with a further scan after four cycles of chemotherapy.The study was designed to assess the response of cerebral metastases to che...

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Section: Response To Chemotherapymentioning

confidence: 76%

The response of cerebral metastases in small cell lung cancer to systemic chemotherapy

Twelves

Souhami²,

Harper³

et al. 1990

Br J Cancer

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“…Promptly she developed 2 brain metastases 8 months after diagnosis and had to undergo therapeutic irradiation. In several studies there was no significant influence of central nervous system metastases on survival, because the patient died earlier from extracerebral disease [2,10,11]. However, patients presenting with brain metastases showed much better survival times than those with delayed development of brain metastases, median survival times of 7 and 3 months, respectively [12].…”

Section: Discussionmentioning

confidence: 99%

“…Only 20% achieve a complete neurological recovery [13]. 65% of the patients who benefit from the irradiation endure a cerebral relapse before their death [11]. Nevertheless, long-term survivors with brain metastases are described in different studies: In the overview by Lassen et al [2], 107 patients showed brain metastases at the time of diagnosis, 3 of them survived more than 5 years.…”

Section: Discussionmentioning

confidence: 99%

Small-Cell Lung Cancer with Brain Metastases and Survival for More than 15 Years despite Incomplete Therapy

Ruhstaller¹,

Thürlimann²

2000

Oncol Res Treat

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Background: 20% of lung cancers are small-cell lung carcinomas. In spite of high radio- and chemosensitivity, the prognosis mostly remains bad. We describe the unusual case of a patient with small-cell lung cancer with brain metastases surviving more than 15 years despite incomplete therapy. Case Report: In 1984, a 56-year-old woman was diagnosed with oat-cell type small-cell lung cancer. At the time of diagnosis the patient presented with limited disease. Six cycles of chemotherapy with doxorubicin, cyclophosphamide, and etoposide were planned. The patient refused therapy after 2 cycles and missed also the proposed prophylactic radiotherapy. In 1985, she developed 2 brain metastases, the staging showed no hint at other metastases. After radiotherapy with 3,000 cGy, she achieved complete remission and remained free of symptoms. Today she lives in an old people’s home and indulges in distinct nicotine abuse. Recurrence or a second malignancy have not occurred until now. Conclusion: Long-term survivors with small-cell lung cancer are often described. In our case very little therapy had a very large effect, the reasons are unclear. This case shows impressively, that cases which according to the literature have the worst prognosis can go unexpectedly well.

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“…The standard therapeutic approach for limited disease is chemotherapy using cisplatinum and etoposide (EP) with concurrent thoracic irradiation. Because EP is relatively well tolerated in combination with radiation, it is preferred over CAV in this setting [45]. Chemotherapy alone does not offer good local control, with local failure rates of 75-90% despite good initial response rates of 80-90%.…”

Section: First-line Therapy In Stage I-iiib (Ld)mentioning

confidence: 99%

“…The alkaloid topotecan is a topoisomerase inhibitor approved by the US Food and Drug Administration for the second-line therapy of SCLC [45,61]. It has also been investigated for use as a first-line agent.…”

Section: Newer Chemotherapeutic Agentsmentioning

confidence: 99%

Update on small cell lung cancer management

Huber¹,

Tufman²

2012

breathe

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SummarySmall cell lung cancers (SCLCs) account for ,15-20% of all lung cancers. Because SCLC is almost always associated with long-term tobacco smoking, abstinence from smoking and smoking cessation are crucial for primary prevention. Because symptoms are generally unspecific, the disease is often diagnosed late, with 70% of patients already in stage IIIb or IV at the time of diagnosis. Early detection of SCLC through screening is under investigation. Chemotherapy, generally a platinum-based combination, is the mainstay of therapy and is generally combined with radiation in the first-line treatment of tumours up to stage IIIb. Surgery has a place in the diagnosis and therapy of stage I SCLC, but plays no key role in advanced cancer. In patients who respond to first-line therapy, prophylactic cranial irradiation can prevent brain metastases and improve overall survival. Although the initial response to treatment is usually good, SCLC tends to relapse quickly. This makes second-line therapy quite important. Topotecan is the most studied and widely used agent in second-line therapy; however, newer agents, including biological therapies, are under study. Statement of interestNone declared.HERMES syllabus links: module B. 2. 1

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Favorable Prognosis of Brain Metastases in Small Cell Lung Cancer

Cited by 65 publications

References 7 publications

The response of cerebral metastases in small cell lung cancer to systemic chemotherapy

The response of cerebral metastases in small cell lung cancer to systemic chemotherapy

Small-Cell Lung Cancer with Brain Metastases and Survival for More than 15 Years despite Incomplete Therapy

Update on small cell lung cancer management

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