Radiotherapy and systemic chemotherapy for brain metastasis in small cell lung cancer

Systemic chemotherapy has been performed for brain metastasis in small cell lung cancer based on the idea that the blood-brain-barrier may not function in the tumor tissue. In order to elucidate the role of radiotherapy and chemotherapy in this situation, a retrospective study was performed. Response rates to radiotherapy and chemotherapy were 55% and 31%, respectively. The median survival times (MST) of radiotherapy alone, chemotherapy alone and combined therapy were 1.6, 4.0 and 6.1 months, respectively, and there were significant differences between radiotherapy alone and combined therapy and between chemotherapy alone and combined therapy. Forty-nine percent of patients who were treated with radiotherapy alone, 63% with chemotherapy alone and 42% with combined therapy died of brain metastasis. The MST of the patients with no prior therapy, relapsed patients whose response to the initial chemotherapy was CR and relapsed patients whose response were PR, were 6.1, 6.1 and 3.3 months, respectively. In the former 2 groups, the presence of brain metastasis is not considered to be a contraindication for chemotherapy. However, chemotherapy should be combined with radiotherapy since relative poor survival and high frequency of death due to tumor were observed when treated with chemotherapy alone, and radiotherapy is considered to be useful as a palliative treatment because of its high response rate and low toxicity. (author)