Patterns of relapse of N2 nonsmall‐cell lung carcinoma patients treated with preoperative chemotherapy

André, Franck; Grunenwald, Dominique; Pujol, Jean Louis; Girard, P.; Dujon, Antoine; Brouchet, L.; Brichon, Pierre-Yves; Westeel, Virginie; Chevalier, T. Le

doi:10.1002/1097-0142(20010615)91:12<2394::aid-cncr1273>3.3.co;2-y

Cited by 21 publications

(18 citation statements)

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“…Conversely, the incidence of BMs has been widely reported in trials of patients with locally advanced NSCLC. Trials of chemotherapy after surgery or radiotherapy in patients with stage IIIA/IIIB NSCLC have found a 20–35% incidence of BMs after a median survival period of 21–36 months 9–13. We found a similar incidence and survival in our population composed almost exclusively of heavily pretreated patients with Stage IV disease.…”

Section: Discussionsupporting

confidence: 75%

High incidence of disease recurrence in the brain and leptomeninges in patients with nonsmall cell lung carcinoma after response to gefitinib

Omuro

Kris

Miller

et al. 2005

Cancer

210

148

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BACKGROUND Gefitinib is an epidermal growth factor receptor tyrosine kinase inhibitor that induces an early and dramatic response in 10% of patients with advanced nonsmall cell lung carcinoma (NSCLC). Long‐ term outcome and patterns of disease recurrence after response have not been described. METHODS The authors evaluated 139 patients with NSCLC treated with gefitinib at Memorial Sloan‐Kettering Cancer Center (New York, NY) between 1998 and 2002. They focused on patterns of disease recurrence, risk of brain metastases (BM) and leptomeningeal metastasis (LM), and long‐term outcome after initial response to gefitinib. RESULTS Of the 139 patients treated with gefitinib, 21 (15%) achieved a partial response. The median age of the responders was 64 years (range, 38–87 years), the median Karnofsky performance score was 80 (range, 60–90), and 4 of the patients were men. All responders had adenocarcinoma. The central nervous system (CNS) was the initial site of disease recurrence in 7 (33%) patients (BM in 5 and LM in 2). In 9 (43%) patients, the initial site of disease recurrence was the lung and in 1 it was the liver and bone. Four (57%) of the patients with disease recurrence in the CNS had lung disease under control. BM also developed in 2 patients who had initial disease recurrence in the lungs. The actuarial 5‐year incidence of CNS metastases was 60%. The median overall survival periods were 15 months and 23 months for patients with and without CNS metastases, respectively (P = 0.24). CONCLUSIONS The CNS was a frequent site of disease recurrence in patients with NSCLC after an initial response to gefitinib, regardless of disease control in the lungs. Patients should be carefully monitored for neurologic symptoms. Intrinsic resistance of metastatic clones, incomplete CNS penetrance of the drug, and longer survival are possible explanations for this high incidence. Cancer 2005. © 2005 American Cancer Society.

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Section: Discussionsupporting

confidence: 75%

High incidence of disease recurrence in the brain and leptomeninges in patients with nonsmall cell lung carcinoma after response to gefitinib

Omuro

Kris

Miller

et al. 2005

Cancer

210

148

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“…Thus, it is necessary to identify the clinical factors of patients who are more likely to develop brain metastases and would be good candidates for PCI. In retrospective analyses of patients with locally advanced NSCLC, adenocarcinoma histology was suggested to have a higher risk of brain relapses and be worthy of more attention concerning brain metastases . Therefore, locally advanced lung adenocarcinoma was specifically analyzed to identify clinical factors predicting brain metastases.…”

Section: Discussionmentioning

confidence: 99%

“…Several clinical factors have been identified to predict brain metastases in locally advanced NSCLC patients, but they are inconsistent among studies . Of these clinical factors, adenocarcinoma histology was suggested to have a higher risk of brain relapses . The objectives of this study were to identify factors associated with development of brain metastases in stage III adenocarcinoma patients who received concurrent chemoradiotherapy and to identify potential candidates for intervention to reduce brain relapses.…”

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confidence: 99%

Brain metastases after definitive concurrent chemoradiotherapy in patients with stage III lung adenocarcinoma: Carcinoembryonic antigen as a potential predictive factor

et al. 2012

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The predictive factors for the development of brain metastases in patients with stage III non-small-cell lung cancer receiving concurrent chemoradiotherapy remain unclear. Several studies have suggested adenocarcinoma as a predictive factor of brain relapses. In the current analysis, we tried to identify the factors associated with brain metastases in stage III lung adenocarcinoma. The demographic and clinical characteristics, site and date of recurrence, and date of death were reviewed in patients with unresectable stage III lung adenocarcinoma who underwent concurrent platinum-based chemoradiotherapy. In total, 116 patients were identified with a median (range) age of 57 (35-74) years. Of these, 86 (74%) were men, all patients had platinum-based chemotherapy, and 100 (86%) received a total dose of 60 Gy in 30 fractions as definitive thoracic radiotherapy. Of the 95 patients with disease progression or recurrence, 19 (16%) developed brain metastases as the sole site of initial recurrence. A total of 43 (37%) patients developed brain metastases at some time during follow-up. Time to brain metastases was significantly associated with the pretreatment carcinoembryonic antigen (CEA) value, with a hazard ratio (95% confidence interval) of 2.64 (1.39-5.02, P = 0.003). Patients who developed brain metastases as the first recurrent site had marginally better survival (log-rank test, P = 0.066) than those with metastases other than brain. In conclusion, stage III lung adenocarcinoma patients with an elevated CEA value before treatment had a higher risk of developing brain metastases after chemoradiotherapy. Further effort is mandatory to control brain metastases in this patient population by a therapeutic strategy based on the tumor histology and pretreatment CEA value. (Cancer Sci 2012; 103: 756-759) R ecent advances in chemotherapy added to radiotherapy have dramatically improved the prognosis of patients with inoperable stage III non-small-cell lung cancer (NSCLC). The current standard treatment for these patients, concurrent thoracic radiotherapy and platinum-based chemotherapy, yields a 5-year survival rate of 16-23%, with acceptable acute and late toxicity. (1,2) However, many patients still die of recurrent disease. Brain metastases, as well as loco-regional recurrences, are the most frequent types of initial failure. Observational studies in patients with stage III NSCLC who underwent chemoradiotherapy with or without surgery showed that the first recurrent site was the brain in only 8-35% of patients, and brain and other sites in 4-10% of patients, resulting in brain metastases as the first recurrent site in 17-43% of patients. (1,3,4) Prophylactic cranial irradiation (PCI) has been tried to eradicate undetectable micrometastases before they become clinically apparent. Prospective randomized trials comparing PCI and observation in patients with locally advanced NSCLC treated by thoracic radiotherapy with or without chemotherapy showed a significant reduction in the development of brain metastases, but no sur...

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“…Symptomatic brain metastases have a negative impact on quality of life (QoL) and are associated with a worse OS [6,7]. Known risk factors for brain metastases are adenocarcinoma histology and younger age [4,8]. Several chemotherapy regimens are used as part of CRT.…”

Section: Introductionmentioning

confidence: 99%

Development of symptomatic brain metastases after chemoradiotherapy for stage III non-small cell lung cancer: Does the type of chemotherapy regimen matter?

et al. 2016

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Patterns of relapse of N2 nonsmall‐cell lung carcinoma patients treated with preoperative chemotherapy

Cited by 21 publications

References 0 publications

High incidence of disease recurrence in the brain and leptomeninges in patients with nonsmall cell lung carcinoma after response to gefitinib

High incidence of disease recurrence in the brain and leptomeninges in patients with nonsmall cell lung carcinoma after response to gefitinib

Brain metastases after definitive concurrent chemoradiotherapy in patients with stage III lung adenocarcinoma: Carcinoembryonic antigen as a potential predictive factor

Development of symptomatic brain metastases after chemoradiotherapy for stage III non-small cell lung cancer: Does the type of chemotherapy regimen matter?

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