1284P - Multimodal strategy may improve survival in non-small cell lung cancer (NSCLC) patients (pt) with brain metastases (BM)

Date 29 September 2012
Event ESMO Congress 2012
Session Poster presentation I
Topics Non-Small-Cell Lung Cancer, Metastatic
Presenter Marie Chaubet Houdu
Authors M. Chaubet Houdu1, C. Le Pechoux2, E. Lanoy3, D. Bouda3, B. Besse4
  • 1Gustave Roussy, 94805 - villejuif/FR
  • 2Radiotherapy, Gustave Roussy, 94805 - villejuif/FR
  • 3Biosatitistics, Gustave Roussy, 94805 - villejuif/FR
  • 4Dept. Of Medicine, Gustave Roussy, 94805 - villejuif/FR

Abstract

Background

BM occur in approximately 50% of all lung cancer. Local treatment of BM consist of whole brain radiation therapy (WBRT), stereotactic radiation surgery (SRS) and or surgical resection. Median overall survival (OS) remain poor: ranges observed in previous study were 4.8-13 months (m), 2.8-6 m and 2-4 m for RPA I, II and III. We evaluated the long-term outcome of NSCLC pts with BM treated by WBRT at least.

Methods

We conducted a retrospective analysis of pts treated at the Gustave-Roussy Institute, between April 2002 and April 2010. Inclusion criteria were: NSCLC histology, BM and WBRT performed in our institution. Synchronous diagnosis of BM was defined as a delay less than 3 month between NSCLC and BM diagnoses. OS from time of NSCLC diagnosis and time of BM diagnosis were estimated using Kaplan-Meier method. Association between delayed WBRT, after at least 2 cycles of chemotherapy (CT) or not, and death was evaluated using multivariable Cox proportional hazards model adjusted for gender, histology, smoking status and RPA score.

Results

We included 175 consecutive pts: 61% were male, median age was 57 years [range = 27-79]. 68% had adenocarcinoma, 15% were never smoked. At first diagnosis of NSCLC, the TNM 2009 stage was mainly IV (68%) and III (21%). 42 % of BM were synchronous and 36% pts had no extracranial metastasis. The number of BM was: one in 34%, and more than three lesions in 41%. Karnofsky index was >= 70% in 79% of pts. The RPA class was good-I in 13 pts and poor-III in 37 pts. Radical surgery was performed in 23 pts (16%) while 8 pts (4.6%) received SRS. 70% had CT with a median nbr of 1 line [0-6], 31% were treated with anti EGFR therapy. Median OS from NSCLC diagnosis was 18 (95%CI = [15;20]) months. Median OS from BM diagnosis was 9m (95%CI = [7.6;10.6]) for the whole population, 43 m for RPA class I, 10 m for class II and 2 m for class III. In 26% of the pts, WBRT was delayed and delayed WBRT was not associated with survival in multivariable analysis (HR = 1.24 95%CI.0.85-1.80).

Conclusions

Our results suggest that in NSCLC with BM, RPA class II could be easily treated with systemic therapy, with then long survival, selected RPA class III may benefit WBRT and systemic treatment. ALK and EGFR status will be presented.

Disclosure

All authors have declared no conflicts of interest.