The Stereotactic Radiotherapy For Brain Metastases From Lung Cancer

Objective To assess the clinical efficacy and prognostic factors of Stereotactic Radiotherapy (SRT) for patients with brain metastases(BM) from lung cancer.Methods From March1995to July2006,152consecutive patients with BM from lung cancer were treated by SRT. Fifty nine patients SRT alone,40patients concurrent SRT and whole brain radiotherapy (WBRT), and53patients after WBRT failure salvaged by SRT.Results The follow-up rate was97.5%in the group, the half year and1year local control rate for SRT alone group, concurrent group, salvage group were96%,93.4%,94.2%,90.8%,81.7%,77.5%(χ2=5.39, P=0.068), the1-,2-,5year survival rate for three groups were47.4%,23.7%,8.5%,55%,20%,0%,41.5%,7.5%,1.9%, and the median overall survival were11,12,11months(χ2=4.08,P=0.13).The univariate analysis showed that the interval from diagnosis of lung cancer to BM, KPS, thoracic surgery, GPA grade, RPA class, system disease stable were significant prognostic factors (χ2=11.97,5.91,15.48,14.48,15.86,17.36, P=0.001,0.015,0.000,0.000,0.000,0.000). The RPA class, thoracic surgery were the independent prognostic factors (χ2=21.02,8.18, P=0.000,0.004). KPS score less than70,80and90for all patients before SRT and3months later after SRT were48.7%,33.6%,17.8%;27.0%,46.7%,26.3%respectively(t=7.161, p=0.00).Conclusions A definitive benefit of SRT is observed in the treatment of lung cancer with BM; there is no difference of survival between SRT only, concurrent treatment and the salvage treatment. SRT can improve the patients'KPS score. Thoracic surgery, RPA class were the independent prognostic factors impacting the survival of lung cancer with BM. Objective Evaluation the Fractionated Stereotactic Radiotherapy (FSRT) for the Patients with small-cell lung cancer (SCLC) after the whole brain radiotherapy (WBRT) failure.Methods We retrospectively analyzed35patients with brain metastases from small-cell lung cancer treated with Fractionated linear accelerator (LINAC) FSRT after the WBRT failure. Multivariate analysis was used to determine significant prognostic factor related to survival.Results The median over-all survival (OS) was10.3(1-30) months after FSRT. Controlled extra cranial disease was the only factor identified as being significant predictor of increased OS (χ2=4.02, p=0.045). The median OS time from the diagnosis of brain metastasis was22(6-134) months.14patients died from brain metastasis,14died from extra-cranial progression,1patients died from leptomeningeal metastases, and3died from other causes. Local control at6months and12months was90.6%and76.2%respectively. No significant late complications. New brain metastases outside of the treated area developed in17.1%(6) of patients at a median time of4(2-20) months; All patients had received previous WBRT.Conclusions Fractionated stereotactic radiotherapy was safe and effective treatment for recurrence small-cell lung carcinoma brain metastases. Objective To assess the imaging results of brain metastases(BM) from lung cancer after Stereo tactic Radiotherapy (SRT) and the Clinical evaluation methods.Methods From February2007to July2010,30consecutive patients with60BM lesions from lung cancer were treated by SRT. A radiation therapist and an imaging expert to evaluate the lesions control or not according to the imaging findings and patients'sign and symptom, and evaluate the imaging according to the RECIST criteria in the same time.Results The follow-up rate was100%in the group, the half-,1-,2-,3years lesions local control rates were88.2%,86.4%,78.4%,71.4%, the1-,2-,4year survival rates were83.9%,67.1%,40.9%, and the median overall survival were37months (range,4-56months).The imaging findings after SRT of60lesions including the following3kinds of situation:Uncontrolled14(24%) lesions, eight lesions showed nodular enhancement, five lesions showed homogeneous enhancement, one lesion showed heterogeneous enhancement, for the13progression lesions salvage by repeated SRT, six lesions showed nodular enhancement, seven lesions showed inhomogeneous enhancement after the second time SRT; eleven lesions (18%) suspicious progress, mainly heterogeneous enhancement of the three lesions, heterogeneous enhancement of5lesions; thirty five (58%) lesions control, nineteen lesions disappeared or shrink, and10lesions did not change significantly compare to the pre-treatment volume, but the lesion enhancement weakened. The median time to recurrence were4.5months (rang,2-13months) for Recurrence lesions, the median time of suspicious progress were22months(range,10-33months) for suspicious progress lesions(F=18.91, p=0.000). Ten suspicious progress lesions increased in size, five patients treated by targeted therapy and chemotherapy, one patient treated by chemotherapy alone, two patients treated by targeted therapy alone. All lesions were evaluated by RECIST criteria after SRT:fifteen lesions were CR (25%), nine lesions were PR (15%), twelve lesions were SD(20%),24lesions were PD(40%), response rate (CR+PR+SD) was60%.Conclusions MRI findings of brain metastasis from lung cancer treated by SRT varied,82%of the lesions are prone to judge the efficacy,18%of the lesions is difficult to judge by MRI and requires the use of other examination methods, chemotherapy and targeted therapy after SRT may cause lesions increase in size; RECIST criteria not fully take into account lesions necrotic and getting bigger after SRT, underestimate the efficacy of the treatment, should be combined the treatment with clinical symptoms evaluated.