Efficacy of temozolomide combined with concurrent whole brain radiotherapy for lung cancer with brain metastases

ZHANG Yu; TAO Hai-tao; WANG Jin-liang; MA Jun-xun; DONG Wei-wei; HU Yi

Abstract：Objective:To assess the efifcacy and safety of temozolomide (TMZ) combined with whole brain radiotherapy in the treatment of lung cancer patients with brain metastases.Methods:A total of 24 lung cancer patients with brain metastases were enrolled in this retrospective study. The whole brain radiotherapy with the total dose of 40 Gy (2 Gy per time, 5 times per week) was given to all the patients, and another 10–20 Gy of intensity-modulated boosting therapy for local lesion was given if necessary. All patients took temozolomide (75 mg·m-2) concurrently during the whole course of radiotherapy. Temozolomide should be stopped, if the patient can not tolerate adverse reactions. After radiotherapy, the patients received systematical chemotherapy or continued TMZ therapy (150–200 mg·m-2·d-1, 5/28 d) for additional 0–6 cycles according to the condition of the patients. The efifcacy and adverse reactions were evaluated statistically.Results:All the patients ifnished the radiotherapy combined with concurrent TMZ. Afterwards, 10 patients received systematical chemotherapy, 7 patients received the best supportive treatment, 3 patients received additional 4 cycles of TMZ adjuvant therapy, and 3 patients continued 6 cycles of TMZ chemotherapy. After radiotherapy and chemotherapy, 2 patients had complete response, 7 patients had partial response, 12 patients had stable disease, while the other 3 patients had progressed disease by evaluation of intracranial lesion. Therefore, the total effective rate achieved 37.5%, the disease control rate obtained 87.5%, the median PFS was 5 months, the median intracranial lesions PFS was 6 months. Acute side-effects were developed in 18 patients. GradeⅢorⅣhematologic toxicities were developed in 3 patients (12.5%), but gradeⅢ–Ⅳnon-hematologic side-effects were developed in 4 patients (16.7%).Conclusion:Temozolomide was well tolerant, and showed signiifcant improvements in response rate when combined with whole brain radiotherapy in lung cancer with brain metastases. While, the beneift of long-term survival needs to be veriifed by further clinical studies.