20Jun 2017

CONCURRENT WHOLE BRAIN IRRADIATION WITH OR WITHOUT TEMOZOLOMIDE IN TREATMENT OF BRAIN METASTASES FROM BREAST CANCER.

  • Clinical Oncology Department, Faculty Of Medicine, ZagazigUniversity ,Egypt.
Crossref Cited-by Linking logo
  • Abstract
  • References
  • Cite This Article as
  • Corresponding Author

Background: to evaluate the response rate , survival and safety of the combination of temozolamide and whole brain radiotherapy in breast cancer patients with previously untreated brain metastases Patients and Methods:40 patients with brain metastases were divided in two groups Control arm(A): patients received whole brain radiotherapy(WBRT) at a dose of 30 Gy in 10 daily fractions over 2 weeks. TMZ plus WBI arm (B): patients treated with (WBRT) at a dose of 30 Gy in 10 daily fractions over 2 weeks concomitant with temozolamide. The primary endpoint was overall response (OR) Secondary endpoints were progression free survival (PFS) and overall survival ( OS) Results: Patients who received WBI and TMZ had an overall response of 45% compared with 40% in WBI alone with no statistically significant difference. Brain metastasis progression was observed in 45% in the control group(A) versus 15% in group B with a statistically significant difference (p=0.038) . Median progression free survival ( PFS) was 6 months in group A but 9.5 in group B with non significant difference. One year progression free survival was 37.5% in group A versus 45% in group B . One year overall survival was 33.3% in group A versus 47.8% in group B . Median overall survival was 7 months in group A versus 11 months in group B with non-significant difference. Most of patients had tolerable side effects and recovered eventually. Conclusion: Although, the combination of WBRT and TMZ was safe and appeared to improve local control , OS and PFS of BMs from breast cancer in this study, this improvement was non- significant, and further studies with larger number of patients are needed to get significant results.

  1. Langer CJ, Mehta MP. Current management of brain metastases, with a focus on systemic options.JClinOncol. 2005;23:6207?19. doi: 10.1200/JCO.2005.03.145. PMID:16135488.
  2. Pestalozzi, B.C.(2009), Brain metastases and subtypes of breast cancer. Ann Oncol, 2009. 20(5): p. 803-5.
  3. Cappuzzo F, Mazzoni F, Maestri , Di Stefano A, Calandri C, Crino L: Medical treatment of brain metastases from solid tumours Forum? Genova) 2000, 10:137-149.
  4. Scoccianti S, Ricardi U. Treatment of brain metastases: review of phase III randomized controlled trials. RadiotherOncol. 2012;102:168?79. doi: 10.1016/j.radonc.2011.08.041. PMID:21996522
  5. John H. Suh, MD, Samuel T. Chao, MD, and Michael A. Vogelbaum, MD, PhD.(2009). (Management of brain metastases 2009) Current Neurology and Neuroscience Reports(Journal),? , 9:223?230 Current Medicine Group LLC ISSN 1528-4042 Copyright ? 2009
  6. vanVulpen M, Kal HB, Taphoorn MJ, El-SharouniSY.Changes in blood-brain barrier permeability induced byradiotherapy: implications for timing of chemotherapy? (Review).Oncol Rep 2002; 9: 683-688 [PMID: 12066192
  7. Addeo R, Caraglia M, Faiola V, Capasso E, et al. Concomitant treatment of brain metastasis with whole brain radiotherapy [WBRT] and temozolomide [TMZ] is active and improves quality of life. BMC Cancer. 2007;7: 18. doi: 10.1186/1471-2407-7-18. PMID:17254350
  8. Christodoulou C, Bafaloukos D, Linardou H, AravantinosG. Temozolomide(TMZ) combined with cisplatin (CDDP) in patients with brain metastases from solid tumors: a Hellenic Cooperative Oncology Group (HeCOG) Phase II study. J Neurooncol 2005;71: 61-65 [PMID: 15719277 DOI: 10.1007/s11060-004-9176-0]
  9. Gamboa-Vignolle C, Ferrari-Carballo T, Arrieta ?, Mohar A. Whole-brain irradiation with concomitant daily fixed-dose Temozolomide for brain metastases treatment: A randomised phase II trial. RadiotheryOncol. 2012;102:187?191. doi: 10.1016/j.radonc.2011.12.004. PMID:22257825
  10. Zhao Q, Qin Q, Sun J, Han D, Wang Z, Teng J, et al. (2016) Brain Radiotherapy plus Concurrent Temozolomide versus Radiotherapy Alone for Patients with Brain Metastases: A Meta-Analysis. PLoS ONE 11(3): e0150419. doi:10.1371/journal.pone.0150419
  11. Cao KI, Lebas N, Gerber S, Levy C, Le Scodan R, BourgierC,et al. Phase II randomized Study of Whole Brain Radiation Therapy with or without concurrent temozolomide for Brain Metastases from breast cancer. Ann Oncol. 2015;26:89?94. doi: 10.1093/annonc/mdu488. PMID:25355723
  12. Verger E, Gil M, Yaya R, Vi?olas N, Vill? S, Pujol T, et al. Temozolomide and concomitant Whole Brain radiotherapy in patients with Brain Metastases a Phase II randomized trial. Int J RadiatOncolBiol Phys. 2005;61:185?191. PMID:15629610doi: 10.1016/j.ijrobp.2004.04.061
  13. TosoniA, Cavallo G, Ermani M, et al. Is protracted low-dose temozolomidefeasible in glioma patients? Neurology 2006;66:427?9.
  14. AntonadouD,Coliarakis N, Paraskevaidis M, Athanasiou H, e tal. A multi‐institutional trial comparing survival of patients with brain metastases fromlung cancer treated with temozolomide plus radiotherapy versus to radiotherapy alone. LungCancer. 2003;41:S22?3.
  15. Antonadou D, Paraskevaidis M, Sarris G, ColiarakisN,Economou I, Karageorgis P, Throuvalas N. Phase II randomizedtrial of temozolomide and concurrent radiotherapyin patients with brain metastases. J ClinOncol 2002; 20:3644-3650 [PMID: 12202665]
  16. Qin H, Pan F, Li J, Zhang X, Liang H, Ruan Z. Whole Brain Radio therapy Plus Concurrent Chemotherapy in Non-Small Cell Lung Cancer Patients with Brain Metastases: A Meta-Analys. PLoS One. 2014;9:e111475. doi: 10.1371/journal.pone.0111475. PMID:25347291
  17. Dziadziuszko R, Ardizzoni A, Postmus PE, Smit EF, Price A, Debruyne C, et al. Temozolomide in patients with advanced non-small cell lung cancer with and without brain metastases: a phase II study of the EORTC Lung Cancer Group (08965). Eur J Cancer. 2003;39:1271?1276. PMID:12763216doi: 10.1016/s0959-8049(03)00234-x
  18. Pesce GA, Klingbiel D, Ribi K, Zouhair A, von Moos R, Schlaeppi M, et al. Outcome, quality of life and cognitive function of patients with brain metastases from non-small cell lung cancer treated with whole brain radiotherapy combined with gefitinib or temozolomide. A randomised phase II trial of the Swiss Group for Clinical Cancer Research (SAKK 70/03).Eur J Cancer. 2012;48:377?384. doi: 10.1016/j.ejca.2011.10.016. PMID:22093943
  19. Chua D, Krzakowski M, Chouaid C, Pallotta MG, Martinez JI, Gottfried M, et al. Whole-Brain Radiation Therapy Plus Concomitant Temozolomide for the Treatment of Brain Metastases From Non-Small-Cell Lung Cancer: A Randomized, Open Label Phase II Study. Clin Lung Cancer. 2010;11:176?181. doi: 10.3816/CLC.2010.n.022. PMID:20439193
  20. Hassler MR, Pfeifer W, Knocke-Abulesz TH, Geissler K, Altorjai G, Dieckmann K, et al. Temozolomide added to whole brain radiotherapy in patients with multiple brain metastases of non-smallcell lung cancer: a multicentric Austrian phase II study. Wien KlinWochenschr. 2013;125:481?486. doi: 10.1007/s00508-013-0402-7. PMID:23907204
  21. Sperduto PW, Wang M, Robins HI, Schell MC, Werner-Wasik M, Komaki R, et al. A Phase 3 Trial of Whole Brain Radiation Therapy and Stereotactic Radiosurgery Alone Versus WBRT and SRS WithTemozolomide or Erlotinib for Non-Small Cell Lung Cancer and 1 to 3 Brain Metastases: Radiation Therapy Oncology Group 0320. Int J RadiatOncolBiol Phys. 2013;85:1312?1318. doi: 10.1016/j.ijrobp.2012.11.042. PMID:23391814
  22. Brett L. Carlson, B.S.,1 Patrick T. Grogan,1 Ann C. Mladek, B.S, et al. Radiosensitizing effects of TMZ observed in vivo only in a subset of MGMT methylated GBM xenograftsInt J RadiatOncolBiol Phys. 2009 Sep 1; 75(1): 212?219.

[Mohamed abdelgawad, Eman Ismail and Abbas Sarhan. (2017); CONCURRENT WHOLE BRAIN IRRADIATION WITH OR WITHOUT TEMOZOLOMIDE IN TREATMENT OF BRAIN METASTASES FROM BREAST CANCER. Int. J. of Adv. Res. 5 (Jun). 996-1004] (ISSN 2320-5407). www.journalijar.com

mohamed abdelgawad
clinical oncology department, Faculty of Medicine, Zagazig University

DOI:

Article DOI: 10.21474/IJAR01/4502      
DOI URL: http://dx.doi.org/10.21474/IJAR01/4502

Download Full Paper

Download PDF No. of Downloads: 12 | No. of Views: 57