The efficacy and roles of combining temozolomide with whole brain radiotherapy in protection neurocognitive function and improvement quality of life of non-small-cell lung cancer patients with brain metastases

Autor: Congying Xie, Xia Deng, Lihao Zhao, Zhenghua Fei, Xiance Jin, Hanbin Chen, Huafang Su, Zhen Zheng, Shaoran Fei, Baochai Lin
Jazyk: angličtina
Předmět:
0301 basic medicine
Oncology
Male
Cancer Research
Lung Neoplasms
0302 clinical medicine
Carcinoma
Non-Small-Cell Lung
Aged
80 and over
Brain Neoplasms
Chemoradiotherapy
Whole brain radiotherapy
Middle Aged
Prognosis
Dacarbazine
Survival Rate
030220 oncology & carcinogenesis
Female
medicine.drug
Research Article
Adult
Quality of life
medicine.medical_specialty
Neurocognitive Disorders
Adenocarcinoma
Verbal learning
03 medical and health sciences
Internal medicine
Statistical significance
medicine
Temozolomide
Genetics
Humans
Lung cancer
Survival rate
Antineoplastic Agents
Alkylating
Aged
Neoplasm Staging
Retrospective Studies
business.industry
Cancer
Brain metastases
medicine.disease
Neurocognitive function
Surgery
030104 developmental biology
Cranial Irradiation
business
Non-small-cell lung cancer
Brain metastasis
Follow-Up Studies
Zdroj: BMC Cancer
ISSN: 1471-2407
DOI: 10.1186/s12885-016-3017-3
Popis: Background Brain metastasis (BM) is a poor prognostic factor for non-small-cell lung cancer (NSCLC). The efficacy and roles of combining temozolomide (TMZ) with whole brain radiotherapy (WBRT) in protection neurocognitive function (NCF) and improvement quality of life (QOL) were investigated and compared with WBRT alone in the treatment of NSCLC patients with BM. Methods A total of 238 NSCLC patients with BM were reviewed and categorized into WBRT plus TMZ (RCT) arm and WBRT alone (RT), respectively. The efficacy was evaluated with Pearson chi-square or Fisher’s exact tests, Log-rank test and Cox proportional hazards model. NCF was assessed by using revised Hopkins Verbal Learning Test (HVLT-R), Controlled Oral Word Association (COWA) test and Trail-making Test (TMT). QOL was assessed by the Functional Assessment of Cancer Treatment-Lung (FACT-L) Chinese version 4.0 questionnaire. Results The average intracranial objective response (ORR) and disease control rate (DCR) for all the patients were 26.9 and 95.8%, respectively. The intracranial ORR and DCR for RCT and RT arm were 34.9% vs. 20.2% (p = 0.01) and 98.4% vs. 92.7% (p = 0.03), respectively. The median intracranial progression-free survival (PFS) and overall survival (OS) of NSCLC patients with BM were 5.2 and 7.3 months, respectively. The median PFS of RCT arm was significantly longer than that of RT arm (5.9 vs. 4.9 months, p = 0.002). The median OS of the RCT arm was also slightly longer than that of the RT arm (8.5 vs. 5.9 months), but without statistical significance (p = 0.11). Multivariate analysis indicated that TMZ was a significant factor for PFS. Statistically significant differences on NCF and QOL were observed between CRT and RT arms at 5 months. RCT showed a trend of toxicities increase compared with RT, however, the toxicities were tolerable and manageable. Conclusions Adding TMZ to WBRT in the treatment of NSCLC patients with BM could improve the intracranial ORR, DCR, and median PFS compared with WBRT alone. Although no remarkable difference on median OS was found, adding TMZ could prevent NCF and QOL from worsening. The side effects increased by adding TMZ, but the difference was not statistical significance and toxicities were well tolerated.
Databáze: OpenAIRE
Externí odkaz: